Practice Test GeeksCRCR - Certified Revenue Cycle Representative Program Practice Test
← All CRCR Flashcard Decks

CRCR - Certified Revenue Cycle Representative Program Insurance Verification and Authorization Flashcards

6 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 6 CRCR - Certified Revenue Cycle Representative Program Insurance Verification and Authorization flashcards as text

  1. What is the purpose of reviewing an Explanation of Benefits during the insurance verification process?

    Answer: To understand how a patient's plan pays for specific services and what the patient's cost-sharing responsibilities are

    The EOB outlines plan benefits, coverage limitations, and patient cost-sharing which is essential for accurate financial counseling.

  2. A patient's insurance verification reveals a $2,500 deductible with $1,800 already met for the year. What is the patient's remaining deductible exposure?

    Answer: $700

    The remaining deductible is the difference: $2,500 minus $1,800 equals $700.

  3. What does in-network versus out-of-network mean for a patient seeking services?

    Answer: In-network providers have a contracted rate with the patient's insurer resulting in lower cost-sharing; out-of-network providers may cost significantly more

    In-network providers have negotiated rates with the insurer which reduces the patient's out-of-pocket costs compared to out-of-network providers.

  4. Which information is typically required when calling a payer to verify insurance eligibility?

    Answer: The patient's name, date of birth, insurance ID number, and the provider's NPI

    Payers use the patient's demographics, insurance ID, and provider NPI to look up and verify coverage.

  5. What is the consequence of billing a service that required prior authorization but for which authorization was not obtained?

    Answer: The claim will typically be denied and the provider may be responsible for writing off the balance

    Most payers require prior authorization for specific services and failure to obtain it results in a claim denial that the provider generally cannot bill to the patient.

  6. What is concurrent review in the context of utilization management and prior authorization?

    Answer: A review conducted during an inpatient stay to determine if continued hospitalization is medically necessary

    Concurrent review is the ongoing clinical review by a payer to determine whether continued inpatient care remains medically necessary.