Account Follow-Up and Collections Flashcards
7 cards from real CRCR practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Account Follow-Up and Collections flashcards as text
What does 'self-pay follow-up' typically involve in a hospital revenue cycle?
Answer: Contacting uninsured or underinsured patients regarding outstanding balances and payment options
Self-pay follow-up focuses on working directly with patients who have no or limited insurance coverage to collect balances owed.
A payer downcodes a submitted evaluation and management (E&M) service from a level 5 to a level 3. What is the appropriate response?
Answer: Submit a claim reconsideration with supporting documentation
A claim reconsideration with physician documentation can support restoring the originally billed E&M level.
What is a 'zero pay' remittance advice?
Answer: An EOB indicating the payer processed the claim but paid nothing
A zero pay EOB means the payer adjudicated the claim but issued no payment, often due to a denial or patient responsibility.
Which of the following best describes 'balance billing' in the context of network contracts?
Answer: Charging the patient for amounts beyond the contracted rate
Balance billing occurs when a provider bills a patient for the difference between billed charges and the contracted rate, which is generally prohibited for in-network providers.
What action should be taken when a duplicate claim denial is received?
Answer: Verify whether the original claim was paid or is still pending
Checking if the original claim was paid or is in process prevents unnecessary resubmission and resolves the account correctly.
Which financial assistance program helps determine if an uninsured patient qualifies for reduced or waived hospital charges?
Answer: Charity care or financial assistance program
Charity care or financial assistance programs evaluate patient income and circumstances to provide discounted or free services to qualifying individuals.
When a payer requests a refund for an overpayment, what should the provider do FIRST?
Answer: Verify the refund request by comparing the EOB and payment records
Verifying the overpayment claim against remittance records ensures accuracy before any refund is processed.