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

The HIPAA 837 transaction is the standard electronic format for submitting professional (837P), institutional (837I), and dental (837D) claims to payers.

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

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.

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 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.

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

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.

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 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.

CRCR - Certified Revenue Cycle Representative Program Practice Test

CRCR - Certified Revenue Cycle Representative Program Practice Test

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