CRCR CRCR - Certified Revenue Cycle Representative Program Insurance Verification and Authorization 2

Question 1

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

Accepted Answer

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

Answer

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

Question 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?

Accepted Answer

$700

Answer

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

Question 3

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

Accepted 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

Answer

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

Question 4

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

Accepted Answer

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

Answer

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

Question 5

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

Accepted Answer

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

Answer

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.

CRCR - Certified Revenue Cycle Representative Program Practice Test

CRCR - Certified Revenue Cycle Representative Program Practice Test

CRCR CRCR - Certified Revenue Cycle Representative Program Insurance Verification and Authorization 2