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 patient disputes a balance, claiming they never received an Explanation of Benefits (EOB) from their insurer. What is the best response from the revenue cycle representative?
Answer: Advise the patient to contact their insurer for the EOB and place a short hold on the account while the dispute is investigated
Directing the patient to obtain their EOB and placing a temporary hold allows time to investigate without damaging the patient relationship or prematurely escalating the account.
Which action best supports compliance when a patient requests validation of a debt being collected by a healthcare organization's in-house team?
Answer: Provide the patient with an itemized statement showing dates of service, charges, and amounts applied by insurance
An itemized statement with dates of service, charges, and insurance payments is the standard method for validating a healthcare debt upon patient request.
When a payment plan agreement is established with a self-pay patient, what is the most important element to document?
Answer: The agreed payment amount, frequency, start date, and consequences for default, along with the patient's signature
A complete payment plan agreement must capture payment terms, schedule, default consequences, and the patient's authorization to be enforceable and compliant.
What is the significance of a payer's 'timely filing limit' in the context of account follow-up?
Answer: It is the deadline by which a claim must be submitted to the payer or it will be denied and typically cannot be appealed
Timely filing limits are payer-set deadlines for claim submission; missing the deadline typically results in a denial that cannot be reversed, causing permanent revenue loss.
A claim has been in 'pending' status with a payer for 45 days with no remittance. What is the recommended follow-up action?
Answer: Contact the payer by phone or portal to confirm receipt, check processing status, and document the interaction
Proactive payer follow-up at defined intervals, with documentation of each contact, is the standard practice for claims lingering beyond normal processing timeframes.
Which of the following is an example of a 'soft' collections approach appropriate for early-stage patient balances?
Answer: Sending a friendly patient statement with payment options and financial assistance information
Early-stage collections should use patient-friendly communications that offer multiple payment options and inform patients of assistance programs before escalating to harder tactics.
A revenue cycle manager notices that the Days in A/R has increased from 42 to 58 over the past quarter. Which root cause should be investigated first?
Answer: Rise in claim denials, delayed submissions, or payment posting backlogs
An increase in Days in A/R typically signals upstream issues such as higher denial rates, late claim submissions, or a backlog in posting payments that slow cash collection.