CRCR - Certified Revenue Cycle Representative Program Charge Capture and Coding Flashcards
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Read the first 6 CRCR - Certified Revenue Cycle Representative Program Charge Capture and Coding flashcards as text
What is charge lag and why is it problematic for revenue cycle?
Answer: The delay between patient discharge and charge submission which delays billing and cash flow
Charge lag is the time between when a service is rendered and when it is billed, which delays cash flow and can cause timely filing issues.
Which of the following best describes a revenue code on a UB-04 claim form?
Answer: A three or four digit code identifying the type of service or supply being billed
Revenue codes on UB-04 forms identify the type of service, accommodation, or supply and are required for hospital outpatient and inpatient billing.
What is the function of a modifier in CPT coding?
Answer: To provide additional information about how a service was performed without changing its definition
Modifiers add information about circumstances such as bilateral procedures, multiple procedures, or assistant surgeons without altering the code's meaning.
Under the hospital Outpatient Prospective Payment System, what determines the payment rate for a service?
Answer: The Ambulatory Payment Classification group assigned to the service
Under OPPS, Medicare payments to hospital outpatient departments are based on APC groups, each with a set payment rate.
What is the purpose of a charge reconciliation process at the end of a patient encounter?
Answer: To ensure that all services rendered are captured and no charges are missed or duplicated
Charge reconciliation compares services documented in the medical record against charges submitted to identify missing or duplicate charges.
A coder is unsure whether a procedure qualifies as a separate billable service or is included in another code. What resource should they consult?
Answer: The National Correct Coding Initiative edits
NCCI edits define code pairs that should not be billed together because one is considered included in the other.