CRCR - Certified Revenue Cycle Representative Program Account Follow-Up and Collections Questions and Answers — Questions and Answers
Question 1: An Accounts Receivable (A/R) aging report shows a significant percentage of self-pay accounts in the 91-120 day bucket. What does this primarily indicate a problem with?
- The accuracy of charge capture.
- The effectiveness of the collections process. (Correct answer)
- Timely filing limits with payers.
- The patient registration process.
Correct answer: The effectiveness of the collections process.
A high volume of accounts in older aging buckets, like 91-120 days, directly reflects that efforts to collect outstanding balances have been unsuccessful and cash flow is delayed. While other issues can contribute, the A/R aging report is a primary tool for measuring the performance of the collections process.
Question 2: A patient with a large outstanding balance informs the collections specialist that they recently lost their job and cannot pay. What is the MOST appropriate initial action for the specialist to take?
- Demand at least a partial payment immediately.
- Advise the patient their account will be sent to a third-party agency.
- Screen the patient for eligibility under the hospital's financial assistance policy. (Correct answer)
- Write the account off to bad debt.
Correct answer: Screen the patient for eligibility under the hospital's financial assistance policy.
The most appropriate and patient-centric first step is to determine if the patient qualifies for financial assistance or charity care. Hospitals are required to have financial assistance policies, and this approach helps differentiate between an unwillingness to pay (bad debt) and an inability to pay (charity care).
Question 3: Which of the following activities is restricted under the Fair Debt Collection Practices Act (FDCPA) when performed by a third-party collector?
- Calling a patient at 3:00 PM on a weekday.
- Discussing the details of the debt with the patient's neighbor. (Correct answer)
- Sending the patient a written validation of the debt upon request.
- Offering the patient a payment plan.
Correct answer: Discussing the details of the debt with the patient's neighbor.
The FDCPA strictly limits communication with third parties about a consumer's debt. A collector cannot discuss the debt with most other people, including neighbors or employers, without the consumer's prior consent. This is considered a violation of the consumer's privacy.
Question 4: During a follow-up call, a patient disputes a charge on their statement, stating it is incorrect. What is the best practice for the revenue cycle representative to follow?
- Immediately transfer the patient to the clinical department.
- Insist that the charge is valid and demand payment.
- End the call and note the patient's refusal to pay.
- Listen to the patient, place the disputed amount on hold, and initiate an account review. (Correct answer)
Correct answer: Listen to the patient, place the disputed amount on hold, and initiate an account review.
The best practice is to acknowledge the patient's concern, temporarily pause collection activity on the disputed charge, and begin a formal review process to verify the charge's accuracy. This de-escalates the situation and demonstrates a commitment to resolving the issue fairly.
Question 5: After all internal and external collection efforts for a patient's account have been exhausted and the balance is deemed uncollectible, the amount is typically written off and reclassified as:
- A contractual allowance.
- A denial adjustment.
- Bad debt. (Correct answer)
- Charity care.
Correct answer: Bad debt.
Bad debt refers to services for which the provider expected payment but did not receive it because the patient was unwilling or unable to pay, after collection efforts were made. This is distinct from charity care, where an inability to pay is determined upfront and the provider does not expect reimbursement.
Question 6: Which of the following is a key goal of a proactive account follow-up and collections strategy?
- To increase the number of patient complaints.
- To maximize the amount of contractual allowances.
- To reduce the number of days accounts remain in accounts receivable (A/R). (Correct answer)
- To ensure all claims are submitted within 365 days.
Correct answer: To reduce the number of days accounts remain in accounts receivable (A/R).
A primary objective of effective collections and A/R management is to reduce the average number of days it takes to collect payments. A lower number of days in A/R indicates a healthier cash flow and an efficient revenue cycle.
CRCR - Certified Revenue Cycle Representative Program Account Follow-Up and Collections Questions and Answers
An Accounts Receivable (A/R) aging report shows a significant percentage of self-pay accounts in the 91-120 day bucket.
What does this primarily indicate a problem with?