CRCR CRCR - Certified Revenue Cycle Representative Program Payment Posting and Reconciliation Questions and Answers 1 — Questions and Answers
Question 1: What is the primary purpose of payment posting in the revenue cycle?
- To generate patient statements
- To accurately record payments and adjustments received from payers and patients to the correct accounts (Correct answer)
- To submit claims to secondary payers
- To verify patient insurance eligibility
Correct answer: To accurately record payments and adjustments received from payers and patients to the correct accounts
Payment posting records all payments, contractual adjustments, and denials from remittance advices onto individual patient accounts, keeping accounts receivable current and accurate.
Question 2: What is a 'contractual adjustment' in healthcare payment posting?
- A penalty applied for late claim submission
- The difference between billed charges and the contracted reimbursement rate accepted by the provider (Correct answer)
- An additional fee charged for after-hours services
- A payment made by the patient at the time of service
Correct answer: The difference between billed charges and the contracted reimbursement rate accepted by the provider
A contractual adjustment is the write-off of the difference between a provider's billed charge and the lower contracted rate agreed upon with the payer.
Question 3: What does ERA stand for in healthcare billing, and what is its function?
- Electronic Remittance Advice; an electronic file containing payer payment and adjustment details (Correct answer)
- Early Revenue Assessment; a tool for projecting monthly collections
- Eligibility Review Authorization; a payer pre-approval document
- Electronic Reimbursement Audit; an internal financial review process
Correct answer: Electronic Remittance Advice; an electronic file containing payer payment and adjustment details
An Electronic Remittance Advice (ERA) is the HIPAA 835 transaction set that transmits payer payment and claim adjudication data electronically to the provider's billing system.
Question 4: When a payer makes an overpayment to a provider, what is the appropriate action?
- Apply the overpayment to a future claim
- Retain the overpayment as additional revenue
- Refund the overpayment to the payer promptly (Correct answer)
- Write off the overpayment as a contractual adjustment
Correct answer: Refund the overpayment to the payer promptly
Federal law and payer contracts require providers to identify and refund overpayments promptly; retaining overpayments can constitute fraud.
Question 5: What is the purpose of a 'lockbox' service used by healthcare organizations?
- To securely store paper medical records
- To process and deposit patient and payer payments received by mail on behalf of the provider (Correct answer)
- To manage electronic health record (EHR) access controls
- To hold disputed claim payments pending resolution
Correct answer: To process and deposit patient and payer payments received by mail on behalf of the provider
A lockbox is a bank-managed service that receives, opens, and deposits mailed payments, then transmits remittance data to the provider for posting.
Question 6: What does it mean to 'balance bill' a patient?
- To bill the patient only their copay amount
- To charge the patient the difference between the provider's billed charge and the payer's allowed amount when the provider is out-of-network (Correct answer)
- To send the patient a final statement after all payers have paid
- To collect the deductible before services are rendered
Correct answer: To charge the patient the difference between the provider's billed charge and the payer's allowed amount when the provider is out-of-network
Balance billing occurs when an out-of-network provider charges the patient the difference between their billed charge and the payer's allowed amount, a practice restricted or banned in many states and federal programs.
CRCR CRCR - Certified Revenue Cycle Representative Program Payment Posting and Reconciliation Questions and Answers 1
What is the primary purpose of payment posting in the revenue cycle?