CRCR Account Follow-Up and Collections 4

Question 1

A patient's claim was denied because coverage was terminated before the date of service. What is the best next step?

Accepted Answer

Verify coverage dates and, if coverage existed, provide proof of eligibility to the payer

Answer

Confirming the patient's actual coverage period and submitting proof to the payer can overturn an eligibility-related denial.

Question 2

What is the significance of the 'timely filing limit' in claims follow-up?

Accepted Answer

It is the deadline by which a claim must be submitted to a payer for consideration

Answer

Missing the timely filing limit results in a non-appealable denial, making it critical to monitor submission deadlines by payer.

Question 3

Which metric measures the average number of days it takes a practice to collect revenue after a service is provided?

Accepted Answer

Days in accounts receivable (AR)

Answer

Days in AR measures the average time between service delivery and payment receipt, indicating collection efficiency.

Question 4

A payer denies a claim stating the procedure requires a referral that was not obtained. Which step best resolves this?

Accepted Answer

Retroactively obtain the referral from the primary care physician if allowed by the payer

Answer

Some payers allow retroactive referrals; obtaining one and submitting an appeal may reverse the denial.

Question 5

What is the primary goal of a 'root cause analysis' performed on denied claims?

Accepted Answer

To identify patterns that cause denials and implement process improvements

Answer

Root cause analysis helps identify systemic issues leading to repeated denials so corrective actions can reduce future revenue loss.

CRCR - Certified Revenue Cycle Representative Program Practice Test