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
What is 'secondary billing' in the context of payment posting?
Answer: Submitting a claim to a second insurance plan after the primary payer has adjudicated and paid
Secondary billing involves submitting the remaining balance to a second insurance payer after the primary insurance has paid, along with the primary EOB/remittance information.
Which adjustment code category on an ERA indicates a patient responsibility amount such as a copay or coinsurance?
Answer: PR (Patient Responsibility)
The PR (Patient Responsibility) adjustment group code on an ERA designates the portion of a claim that is the financial responsibility of the patient, such as deductibles, copays, and coinsurance.
What does 'unapplied cash' mean in revenue cycle payment posting?
Answer: Payments received from a payer or patient that cannot be matched to a specific account or claim
Unapplied cash refers to funds received that have not yet been matched and posted to a specific patient account or service, requiring research to properly apply.
Why is timely payment posting critical to the revenue cycle?
Answer: It keeps accounts receivable balances accurate, supports follow-up prioritization, and prevents missed filing deadlines for secondary payers
Timely payment posting keeps AR current and accurate, allowing follow-up staff to prioritize unpaid accounts and ensuring secondary claims or patient bills are generated before deadlines.
What is a 'credit balance' on a patient account, and what action is required?
Answer: A negative balance indicating an overpayment was received; the provider must refund or apply the credit appropriately
A credit balance (negative balance) on a patient account means more was collected than owed; providers are legally required to refund government program overpayments and should resolve all credit balances promptly.
What does 'posting a denial' mean in payment posting workflows?
Answer: Recording the payer's denial reason code on the account to trigger follow-up or appeal action
When posting a denial, staff record the payer's reason code (CARC/RARC) on the account, flagging it for the denial management team to review, appeal, or correct and resubmit.