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
A patient's claim was denied because coverage was terminated before the date of service. What is the best next step?
Answer: Verify coverage dates and, if coverage existed, provide proof of eligibility to the payer
Confirming the patient's actual coverage period and submitting proof to the payer can overturn an eligibility-related denial.
What is the significance of the 'timely filing limit' in claims follow-up?
Answer: It is the deadline by which a claim must be submitted to a payer for consideration
Missing the timely filing limit results in a non-appealable denial, making it critical to monitor submission deadlines by payer.
Which metric measures the average number of days it takes a practice to collect revenue after a service is provided?
Answer: Days in accounts receivable (AR)
Days in AR measures the average time between service delivery and payment receipt, indicating collection efficiency.
A payer denies a claim stating the procedure requires a referral that was not obtained. Which step best resolves this?
Answer: Retroactively obtain the referral from the primary care physician if allowed by the payer
Some payers allow retroactive referrals; obtaining one and submitting an appeal may reverse the denial.
What is the primary goal of a 'root cause analysis' performed on denied claims?
Answer: To identify patterns that cause denials and implement process improvements
Root cause analysis helps identify systemic issues leading to repeated denials so corrective actions can reduce future revenue loss.
Under HIPAA, what must a provider do before sharing a patient's billing information with a third-party collection agency?
Answer: Ensure the agency has a Business Associate Agreement (BAA) in place
A Business Associate Agreement is required under HIPAA when PHI is shared with external vendors like collection agencies.
Which follow-up action is most appropriate when a claim has been pending with a payer for 45 days without a response?
Answer: Contact the payer to check claim status and document the interaction
Proactively contacting the payer and documenting the inquiry maintains claim momentum and creates a follow-up record.