Account Follow-Up and Collections Flashcards

When a claim is denied due to a coordination of benefits (COB) issue, what is the FIRST step in the follow-up process?

Answer: Identify which payer is primary and which is secondary

Determining the correct payer order is essential before resubmitting a COB-related denial.

A payer has not responded to a claim within the timely filing period. What action should a revenue cycle representative take?

Answer: Submit a claim tracer or proof-of-timely-filing documentation

A claim tracer or proof of timely filing can support resubmission even when the original claim response is overdue.

Which type of denial requires the provider to submit additional clinical documentation to support medical necessity?

Answer: Medical necessity denial

Medical necessity denials require clinical records, physician notes, or an appeal with supporting documentation.

What is the purpose of an aging report in the collections process?

Answer: To identify overdue accounts and prioritize collection efforts

Aging reports categorize outstanding balances by time intervals, helping staff prioritize the oldest and largest accounts.

Under the Fair Debt Collection Practices Act (FDCPA), which of the following is PROHIBITED when contacting patients about balances?

Answer: Using threatening or abusive language

The FDCPA prohibits harassment, abuse, and deceptive practices when collecting consumer debts.

A claim is rejected by the clearinghouse before reaching the payer. What is the most likely cause?

Answer: The claim contains a formatting or data entry error

Clearinghouse rejections occur due to technical or formatting errors and must be corrected before resubmission.

Which process involves reviewing a denied claim, gathering supporting documentation, and formally contesting the payer's decision?

Answer: Appeals management

Appeals management is the structured process of challenging a payer's denial with appropriate evidence and documentation.