CRCR Account Follow-Up and Collections 2 — Questions and Answers
Question 1: When a claim is denied due to a coordination of benefits (COB) issue, what is the FIRST step in the follow-up process?
- Write off the balance immediately
- Identify which payer is primary and which is secondary (Correct answer)
- Rebill the patient directly
- Close the account as uncollectable
Correct answer: Identify which payer is primary and which is secondary
Determining the correct payer order is essential before resubmitting a COB-related denial.
Question 2: A payer has not responded to a claim within the timely filing period. What action should a revenue cycle representative take?
- Automatically write off the claim
- Submit a claim tracer or proof-of-timely-filing documentation (Correct answer)
- Bill the patient for the full amount
- Ignore the claim and move on
Correct answer: Submit a claim tracer or proof-of-timely-filing documentation
A claim tracer or proof of timely filing can support resubmission even when the original claim response is overdue.
Question 3: Which type of denial requires the provider to submit additional clinical documentation to support medical necessity?
- Eligibility denial
- Duplicate claim denial
- Medical necessity denial (Correct answer)
- Timely filing denial
Correct answer: Medical necessity denial
Medical necessity denials require clinical records, physician notes, or an appeal with supporting documentation.
Question 4: What is the purpose of an aging report in the collections process?
- To track employee work hours
- To identify overdue accounts and prioritize collection efforts (Correct answer)
- To calculate patient satisfaction scores
- To document insurance contract terms
Correct answer: To identify overdue accounts and prioritize collection efforts
Aging reports categorize outstanding balances by time intervals, helping staff prioritize the oldest and largest accounts.
Question 5: Under the Fair Debt Collection Practices Act (FDCPA), which of the following is PROHIBITED when contacting patients about balances?
- Calling during normal business hours
- Sending a written notice of the debt
- Using threatening or abusive language (Correct answer)
- Providing information about payment plans
Correct answer: Using threatening or abusive language
The FDCPA prohibits harassment, abuse, and deceptive practices when collecting consumer debts.
Question 6: A claim is rejected by the clearinghouse before reaching the payer. What is the most likely cause?
- The claim exceeded the benefit maximum
- The patient's deductible was met
- The claim contains a formatting or data entry error (Correct answer)
- The provider is out of network
Correct answer: The claim contains a formatting or data entry error
Clearinghouse rejections occur due to technical or formatting errors and must be corrected before resubmission.
Question 7: Which process involves reviewing a denied claim, gathering supporting documentation, and formally contesting the payer's decision?
- Write-off processing
- Claim scrubbing
- Appeals management (Correct answer)
- Charge capture
Correct answer: Appeals management
Appeals management is the structured process of challenging a payer's denial with appropriate evidence and documentation.
CRCR Account Follow-Up and Collections 2
When a claim is denied due to a coordination of benefits (COB) issue, what is the FIRST step in the follow-up process?