CRCR - Certified Revenue Cycle Representative Program Account Follow-Up and Collections Flashcards
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Read the first 7 CRCR - Certified Revenue Cycle Representative Program Account Follow-Up and Collections flashcards as text
A claim is denied because the patient's insurance coverage was terminated on the date of service. What is the best course of action?
Answer: Verify eligibility retroactively, identify any active coverage, and re-bill or move to self-pay accordingly
When coverage is denied due to termination, staff should retroactively verify eligibility, check for other active insurance, and either re-bill the correct payer or convert to self-pay.
Which of the following best describes a 'hardship write-off' in the context of healthcare collections?
Answer: A reduction or elimination of patient balance based on demonstrated financial inability to pay
A hardship write-off is granted when a patient demonstrates documented financial inability to pay, often after completing a financial assistance application.
What is the primary risk of placing an account with an external collection agency without first exhausting internal collection efforts?
Answer: The patient relationship may be unnecessarily damaged and revenue may be lost to agency fees
Premature placement with an external agency damages patient relationships and reduces net recovery because agencies retain a percentage of collected amounts.
Under HIPAA, which information may a healthcare organization share with a collection agency working on its behalf?
Answer: The minimum necessary protected health information (PHI) required to perform the collection activity
HIPAA's minimum necessary standard permits sharing only the PHI required for the collection agency to perform its function as a business associate.
A payer issues a recoupment notice stating it will offset future payments to recover an overpayment made 18 months ago. What should the revenue cycle team do first?
Answer: Review the original claim and remittance to determine if the overpayment is valid before accepting or disputing
Before accepting a recoupment, the team should audit the original claim and remittance to confirm whether the overpayment actually occurred and whether the amount is correct.
Which federal law governs the collection practices of third-party debt collectors pursuing patient balances on behalf of healthcare providers?
Answer: Fair Debt Collection Practices Act (FDCPA)
The FDCPA regulates third-party collectors' conduct, including prohibitions on harassment, false statements, and unfair practices when collecting consumer debts.
What does a 'clean claim rate' measure in the context of accounts receivable management?
Answer: The percentage of claims submitted that are accepted and paid on the first submission without rejection or denial
Clean claim rate measures the proportion of claims paid on first submission, reflecting billing accuracy and the efficiency of the revenue cycle.