CRCR - Certified Revenue Cycle Representative Program Claims Processing and Billing Questions and Answers

Question 1

A hospital billing department submits a batch of claims to a third-party entity that reviews the claims for errors, standardizes the data into the HIPAA-compliant format, and then routes them to the appropriate insurance payers.
What is this third-party entity called?

Accepted Answer

Healthcare Clearinghouse

Answer

Revenue Cycle Management Vendor

Answer

Payer Adjudicator

Answer

Third-Party Administrator (TPA)

Question 2

A patient receives a document from their insurance company that details the services billed by the provider, the amount covered by insurance, and the remaining balance the patient is responsible for. This document is not a bill. Which of the following is it?

Accepted Answer

Explanation of Benefits (EOB)

Answer

Electronic Remittance Advice (ERA)

Answer

Advance Beneficiary Notice (ABN)

Answer

Coordination of Benefits (COB) form

Question 3

A clinic uses software to automatically review outpatient claims for missing diagnosis codes, incorrect patient demographic information, and potential unbundling issues before they are sent to the payer. What is this automated review process known as?

Accepted Answer

Claim Scrubbing

Answer

Adjudication

Answer

Eligibility Verification

Answer

Remittance Posting

Question 4

A claim is denied with a Claim Adjustment Reason Code (CARC) of CO-29. What is the most likely reason for this denial?

Accepted Answer

The claim was submitted after the payer's filing deadline.

Answer

The service is a non-covered charge.

Answer

The claim is a duplicate of one already processed.

Answer

The patient's coverage was terminated.

Question 5

A patient is seen by their primary care physician for a follow-up visit. Which standard claim form would be used to bill for the physician's professional services?

Accepted Answer

CMS-1500 (HCFA-1500)

Answer

UB-04 (CMS-1450)

Answer

Advance Beneficiary Notice (ABN)

Answer

Explanation of Benefits (EOB)

Question 6

After a payer processes a batch of claims, it sends a single electronic file to the hospital's billing system that provides payment and adjustment details for multiple patients. This file allows for automated posting of payments to patient accounts. What is this file called?

Accepted Answer

Electronic Remittance Advice (ERA)

Answer

Electronic Data Interchange (EDI)

Answer

Explanation of Benefits (EOB)

Answer

Claim Status Report