CRCR - Certified Revenue Cycle Representative Program Claims Processing and Billing Flashcards
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Read the first 6 CRCR - Certified Revenue Cycle Representative Program Claims Processing and Billing flashcards as text
What is a crossover claim in Medicare billing?
Answer: A Medicare claim that is automatically forwarded to a Medicaid or supplemental insurer for secondary processing
Medicare crossover claims are automatically forwarded to a secondary payer such as Medicaid or Medigap after Medicare adjudicates the claim.
If a claim is denied for lack of medical necessity, what is the first step the biller should take?
Answer: Review the clinical documentation to determine if additional diagnosis codes or clinical notes support the service
Medical necessity denials require reviewing clinical documentation to see if additional codes or clinical notes would clarify necessity.
What is the function of the National Provider Identifier on a claim?
Answer: It uniquely identifies the healthcare provider submitting or rendering the service
The NPI is a unique 10-digit identifier assigned to healthcare providers for use on all HIPAA-standard transactions including claims.
Which claim form is used for inpatient hospital billing to Medicare?
Answer: UB-04 transmitted electronically as 837I
The UB-04 is the standard institutional claim form for hospitals, transmitted electronically as the 837I transaction.
What does timely filing refer to in healthcare billing?
Answer: The payer-specified deadline by which a claim must be submitted after the date of service
Each payer establishes a timely filing deadline after which claims submitted late will be denied and cannot be appealed on clinical grounds.
In outpatient hospital settings, what does split billing describe?
Answer: When the physician bills separately from the hospital for the same patient encounter
Split billing occurs when the physician component and the hospital facility component of a service are billed separately to the same payer for the same encounter.