FREE CRCR Claims Processing and Reimbursement Questions and Answers
What are key steps in ensuring clean claim submission?
Please select 3 correct answers
Clean claims require accurate demographic and insurance details (A), proper coding (B), and timely submission (C). While patient financial responsibility is communicated to the patient, it is not included on the claim submitted to the payer (D).
Which of the following are common reasons for claim denials?
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Common reasons for claim denials include errors in patient information (A), missing prior authorization (B), and incomplete documentation (C). Services covered under a capitated agreement (D) are generally not denied, as they are reimbursed differently.
Which activities help improve reimbursement rates?
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Improving reimbursement involves auditing coding accuracy (A), negotiating effective contracts (B), and ensuring staff are trained on billing and documentation (D). Modifiers (C) are often necessary for accurate claims and should not be avoided indiscriminately.
What is the purpose of the Explanation of Benefits (EOB) or Remittance Advice (RA)?
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EOBs and RAs provide claim processing details (A), inform the provider of payment or denial decisions (B), and indicate patient responsibility (D). They do not serve as proof of patient payment to the provider (C).
Which of the following are key components of denial management?
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Denial management involves tracking trends (A), appealing with complete details (C), and educating staff on how to avoid common mistakes (D). Resubmitting denied claims without corrections (B) is ineffective and may lead to further denials.