CRCR Account Follow-Up and Collections 3

Question 1

What does 'self-pay follow-up' typically involve in a hospital revenue cycle?

Accepted Answer

Contacting uninsured or underinsured patients regarding outstanding balances and payment options

Answer

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?

Accepted Answer

Submit a claim reconsideration with supporting documentation

Answer

A claim reconsideration with physician documentation can support restoring the originally billed E&M level.

Question 3

What is a 'zero pay' remittance advice?

Accepted Answer

An EOB indicating the payer processed the claim but paid nothing

Answer

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?

Accepted Answer

Charging the patient for amounts beyond the contracted rate

Answer

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?

Accepted Answer

Verify whether the original claim was paid or is still pending

Answer

Checking if the original claim was paid or is in process prevents unnecessary resubmission and resolves the account correctly.

CRCR - Certified Revenue Cycle Representative Program Practice Test

CRCR - Certified Revenue Cycle Representative Program Practice Test

CRCR Account Follow-Up and Collections 3