CRCR CRCR - Certified Revenue Cycle Representative Program Account Follow-Up and Collections 2 — Questions and Answers
Question 1: A patient balance of $450 has been unpaid for 90 days. What is the most appropriate next step in the collections process?
- Write off the balance immediately
- Send a second collection notice and offer a payment plan (Correct answer)
- Transfer the account to an external collection agency without notice
- Adjust the balance off as a contractual write-off
Correct answer: Send a second collection notice and offer a payment plan
Standard collections protocol calls for escalating communication and offering payment arrangements before more aggressive action.
After initial billing, a second collection notice with a payment plan offer is the appropriate next step. This gives the patient a structured opportunity to resolve the balance. External collections and write-offs are last resorts, and contractual adjustments only apply to payer-negotiated discounts, not patient balances.
Question 2: Which account follow-up strategy is most effective for reducing days in accounts receivable?
- Waiting for patients to call with questions
- Working accounts by payer bucket and aging category (Correct answer)
- Only following up on balances over $1,000
- Reassigning all accounts to a single collector
Correct answer: Working accounts by payer bucket and aging category
Organizing follow-up by payer and aging ensures the highest-priority accounts receive timely attention.
Working accounts by payer bucket and aging category allows revenue cycle staff to prioritize high-value and oldest accounts, which have the greatest impact on reducing days in AR. Random or reactive follow-up leads to missed timely filing deadlines and uncollected revenue.
Question 3: What does the term self-pay after insurance mean in collections?
- A patient who has no insurance at all
- The remaining balance owed by the patient after insurance has paid its portion (Correct answer)
- An account flagged for charity care
- A balance that has been sent to collections already
Correct answer: The remaining balance owed by the patient after insurance has paid its portion
After insurance adjudicates a claim, the remaining patient responsibility is the self-pay after insurance balance.
Self-pay after insurance refers to the patient's portion of a bill remaining after the insurance company has processed and paid its share. This includes deductibles, copays, and coinsurance. It is distinct from purely uninsured accounts and requires its own collection strategy.
Question 4: Which metric best measures the effectiveness of a collections department?
- Number of patient complaints received
- Collections rate as a percentage of net patient revenue (Correct answer)
- Total number of accounts assigned
- Number of accounts written off annually
Correct answer: Collections rate as a percentage of net patient revenue
The collections rate reflects how much of what is owed is actually collected, which is the core measure of collections effectiveness.
The collections rate calculated as total collections divided by net patient revenue directly measures how effectively the department recovers owed revenue. High complaint counts or write-off totals are lagging indicators of problems, while the collections rate tracks the fundamental goal of the department.
Question 5: When a patient account is referred to an outside collection agency, what must the healthcare organization typically do first?
- Obtain prior authorization from the patient's insurer
- Provide the patient with advance notice per applicable regulations (Correct answer)
- Delete all clinical records associated with the account
- Notify the state insurance commissioner
Correct answer: Provide the patient with advance notice per applicable regulations
Federal and state regulations generally require advance notice before referring accounts to outside agencies.
Before transferring an account to an external collection agency, healthcare organizations must provide the patient with appropriate advance notice, often 30 days, as required by applicable laws including No Surprises Act provisions and state regulations. This notice must explain the intended referral and provide a contact for resolution.
Question 6: A collection letter is returned as undeliverable. What should the revenue cycle team do?
- Immediately write off the balance
- Use skip tracing to locate updated patient contact information (Correct answer)
- File a claim with the payer for the balance
- Mark the account as a bad debt write-off in 30 days
Correct answer: Use skip tracing to locate updated patient contact information
Skip tracing uses available resources to find updated patient contact information when mail is returned undeliverable.
When collection correspondence is returned undeliverable, the appropriate step is skip tracing using internal data, public records, credit bureau information, or vendor services to locate the patient's current address or phone number. Immediate write-off without exhausting collection efforts violates sound revenue cycle practice.
CRCR CRCR - Certified Revenue Cycle Representative Program Account Follow-Up and Collections 2
A patient balance of $450 has been unpaid for 90 days.
What is the most appropriate next step in the collections process?