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
When a commercial payer denies a claim as 'not covered,' which of the following should be reviewed FIRST?
Answer: The payer's Explanation of Benefits and the provider's contract to determine coverage scope
Reviewing the EOB alongside the payer contract clarifies whether the service should in fact be covered and whether an appeal is warranted.
Which of the following best describes a 'soft' credit inquiry versus a 'hard' credit inquiry in the context of patient collections?
Answer: Soft inquiries do not affect a patient's credit score; hard inquiries may impact it
In patient collections, propensity-to-pay tools may use soft inquiries, which don't affect credit scores, unlike hard inquiries from formal credit checks.
A claim is denied because the rendering provider's NPI is not enrolled with the payer. What is the most effective resolution?
Answer: Enroll the provider with the payer and resubmit once credentialing is confirmed
Completing payer enrollment and credentialing for the rendering provider and resubmitting is the correct resolution for NPI-related denials.
Which approach is considered a best practice for reducing bad debt in a hospital's self-pay accounts?
Answer: Screening patients for charity care eligibility and offering payment plans proactively
Early identification of charity care candidates and proactive payment plan offers reduces bad debt and improves patient relations.
What does the term 'appeal level' refer to in the payer denial management process?
Answer: The sequential stages of the formal appeals process available to contest a denial
Appeal levels refer to the ordered stages (first-level, second-level, external review) through which a provider can formally contest a denial.
A revenue cycle department notices that 20% of claims from a specific payer are being denied for 'lack of prior authorization.' What is the best systemic fix?
Answer: Implement a pre-service authorization workflow that captures authorizations before services are rendered
A pre-service authorization workflow prevents prior authorization denials by ensuring approvals are obtained before care is delivered.
Which statement accurately describes the difference between a 'rejection' and a 'denial' in claims processing?
Answer: Rejections occur before adjudication due to errors; denials occur after adjudication based on payer determination
Rejections are identified before the claim enters adjudication and require correction and resubmission; denials result from the payer's coverage or policy decision after review.