CRCR - Certified Revenue Cycle Representative Program Payment Posting and Reconciliation Questions and Answers 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 CRCR - Certified Revenue Cycle Representative Program Payment Posting and Reconciliation Questions and Answers flashcards as text
A Medicare remittance shows a claim was paid at a lower rate due to a Medicare Secondary Payer (MSP) adjustment. What is the correct posting action?
Answer: Post the Medicare payment and bill the patient's primary insurer for the balance
When Medicare is secondary, the primary insurer's balance must be billed for the remaining coordination of benefits amount.
What is the purpose of a 'zero-pay EOB' in the payment posting process?
Answer: It documents a denial or no-payment decision requiring follow-up action
A zero-pay EOB means the payer processed the claim but issued no payment, typically due to a denial that requires follow-up.
A provider receives a payment for $1,500 but the EOB lists two claims totaling $1,400. How should the $100 difference be handled?
Answer: Apply $1,400 to the claims and hold $100 as unapplied cash pending research
The $100 overage should be held as unapplied cash until the source claim is identified rather than arbitrarily allocated.
When a payer applies a payment to the wrong patient's account due to a data entry error, this is called:
Answer: A misapplied payment or misdirected payment
A misapplied or misdirected payment occurs when funds are posted to the wrong patient account and must be transferred.
Which adjustment code category on an ERA indicates that the reduction is due to the patient not meeting their deductible?
Answer: Patient Responsibility (PR)
PR (Patient Responsibility) codes indicate amounts the patient owes, including deductibles, copays, and coinsurance.
A hospital's accounts receivable team discovers that 50 claims were posted with the wrong payer ID, resulting in incorrect contract adjustments. What is the correct resolution?
Answer: Reverse all affected postings, correct the payer ID, and repost with correct contractual adjustments
Incorrect payer ID postings must be reversed and reposted with the correct payer information to ensure accurate contractual adjustments.
What is the primary reason healthcare organizations perform a monthly accounts receivable (A/R) reconciliation to the general ledger?
Answer: To ensure financial statements accurately reflect outstanding receivables and catch posting errors
Monthly A/R-to-general-ledger reconciliation ensures the integrity of financial reporting and surfaces any discrepancies from posting errors.