CRCR - Certified Revenue Cycle Representative Program Payment Posting and Reconciliation Questions and Answers Flashcards
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Read the first 6 CRCR - Certified Revenue Cycle Representative Program Payment Posting and Reconciliation Questions and Answers flashcards as text
Which HIPAA transaction set is used for electronic claim submission to payers?
Answer: HIPAA 837
The HIPAA 837 transaction is the standard electronic format for submitting professional (837P), institutional (837I), and dental (837D) claims to payers.
What is the difference between a 'payment variance' and a 'contractual adjustment' in payment reconciliation?
Answer: A payment variance is an unexpected difference between expected and received payment; a contractual adjustment is the agreed write-off per contract
A contractual adjustment is the anticipated write-off per contract terms, while a payment variance is an unanticipated discrepancy between expected and actual payment that requires investigation.
What is a 'zero-pay' remittance in payment posting?
Answer: A remittance where the payer processed the claim but issued no payment, often due to the patient's deductible
A zero-pay remittance means the payer adjudicated the claim but applied the entire allowed amount to the patient's deductible or other patient responsibility, resulting in no payment to the provider.
In payment reconciliation, what does it mean to 'balance a batch'?
Answer: To verify that total payments posted equal the total received per the deposit
Balancing a batch ensures the total dollar amount of payments posted in the billing system matches the actual bank deposit amount for that batch, preventing posting errors.
What is a 'take-back' or 'recoupment' by a payer?
Answer: A payer's action to recover previously paid amounts it believes were overpaid or paid in error
A recoupment or take-back occurs when a payer offsets future payments or requests a refund to recover amounts it has determined were overpaid on prior claims.
What is the significance of the CARC (Claim Adjustment Reason Code) on an ERA?
Answer: It explains why a payment was adjusted or denied on a specific service line
Claim Adjustment Reason Codes (CARCs) are standardized codes on the ERA that explain why a claim was adjusted, reduced, or denied, guiding follow-up and appeal decisions.