CRCR CRCR - Certified Revenue Cycle Representative Program Payment Posting and Reconciliation Questions and Answers 2

Question 1

Which HIPAA transaction set is used for electronic claim submission to payers?

Accepted Answer

HIPAA 837

Answer

HIPAA 835

Answer

HIPAA 270/271

Answer

HIPAA 276/277

Question 2

What is the difference between a 'payment variance' and a 'contractual adjustment' in payment reconciliation?

Accepted Answer

A payment variance is an unexpected difference between expected and received payment; a contractual adjustment is the agreed write-off per contract

Answer

They are identical terms used interchangeably

Answer

A contractual adjustment is always larger than a payment variance

Answer

A payment variance applies only to Medicare claims

Question 3

What is a 'zero-pay' remittance in payment posting?

Accepted Answer

A remittance where the payer processed the claim but issued no payment, often due to the patient's deductible

Answer

A remittance where the payer paid the full billed amount

Answer

A remittance indicating a duplicate claim was voided

Answer

A remittance for services not yet rendered

Question 4

In payment reconciliation, what does it mean to 'balance a batch'?

Accepted Answer

To verify that total payments posted equal the total received per the deposit

Answer

To match the number of claims submitted to claims paid

Answer

To confirm patient demographic information matches payer records

Answer

To reconcile the charge master with payer fee schedules

Question 5

What is a 'take-back' or 'recoupment' by a payer?

Accepted Answer

A payer's action to recover previously paid amounts it believes were overpaid or paid in error

Answer

A patient's request to cancel a scheduled payment plan

Answer

A provider's request for additional payment after initial adjudication

Answer

A secondary payer's refusal to pay a claim

Question 6

What is the significance of the CARC (Claim Adjustment Reason Code) on an ERA?

Accepted Answer

It explains why a payment was adjusted or denied on a specific service line

Answer

It identifies the rendering provider's specialty

Answer

It indicates the patient's plan deductible amount

Answer

It specifies the payer's timely filing limit