CRCR Account Follow-Up and Collections 3 — Questions and Answers
Question 1: What does 'self-pay follow-up' typically involve in a hospital revenue cycle?
- Billing Medicare for services rendered
- Contacting uninsured or underinsured patients regarding outstanding balances and payment options (Correct answer)
- Submitting secondary insurance claims
- Auditing inpatient coding records
Correct answer: Contacting uninsured or underinsured patients regarding outstanding balances and payment options
Self-pay follow-up focuses on working directly with patients who have no or limited insurance coverage to collect balances owed.
Question 2: A payer downcodes a submitted evaluation and management (E&M) service from a level 5 to a level 3. What is the appropriate response?
- Accept the payment without review
- Write off the difference immediately
- Submit a claim reconsideration with supporting documentation (Correct answer)
- Bill the patient the difference
Correct answer: Submit a claim reconsideration with supporting documentation
A claim reconsideration with physician documentation can support restoring the originally billed E&M level.
Question 3: What is a 'zero pay' remittance advice?
- An EOB showing the payer paid the full billed amount
- An EOB indicating the payer processed the claim but paid nothing (Correct answer)
- A notice that a claim was never received
- A patient statement showing no balance due
Correct answer: An EOB indicating the payer processed the claim but paid nothing
A zero pay EOB means the payer adjudicated the claim but issued no payment, often due to a denial or patient responsibility.
Question 4: Which of the following best describes 'balance billing' in the context of network contracts?
- Billing the payer after the patient has paid
- Charging the patient for amounts beyond the contracted rate (Correct answer)
- Sending a secondary claim after primary adjudication
- Writing off the contractual adjustment
Correct answer: Charging the patient for amounts beyond the contracted rate
Balance billing occurs when a provider bills a patient for the difference between billed charges and the contracted rate, which is generally prohibited for in-network providers.
Question 5: What action should be taken when a duplicate claim denial is received?
- Resubmit the claim with a new date of service
- Verify whether the original claim was paid or is still pending (Correct answer)
- Write off the balance as a contractual adjustment
- Send the claim to collections immediately
Correct answer: Verify whether the original claim was paid or is still pending
Checking if the original claim was paid or is in process prevents unnecessary resubmission and resolves the account correctly.
Question 6: Which financial assistance program helps determine if an uninsured patient qualifies for reduced or waived hospital charges?
- Prior authorization
- Charity care or financial assistance program (Correct answer)
- Prospective payment system
- Coordination of benefits
Correct answer: Charity care or financial assistance program
Charity care or financial assistance programs evaluate patient income and circumstances to provide discounted or free services to qualifying individuals.
Question 7: When a payer requests a refund for an overpayment, what should the provider do FIRST?
- Immediately return the funds without review
- Verify the refund request by comparing the EOB and payment records (Correct answer)
- Deny the refund and close the account
- Bill the patient for the disputed amount
Correct answer: Verify the refund request by comparing the EOB and payment records
Verifying the overpayment claim against remittance records ensures accuracy before any refund is processed.
CRCR Account Follow-Up and Collections 3
What does 'self-pay follow-up' typically involve in a hospital revenue cycle?