CRCR Account Follow-Up and Collections 5

Question 1

When a commercial payer denies a claim as 'not covered,' which of the following should be reviewed FIRST?

Accepted Answer

The payer's Explanation of Benefits and the provider's contract to determine coverage scope

Answer

Reviewing the EOB alongside the payer contract clarifies whether the service should in fact be covered and whether an appeal is warranted.

Question 2

Which of the following best describes a 'soft' credit inquiry versus a 'hard' credit inquiry in the context of patient collections?

Accepted Answer

Soft inquiries do not affect a patient's credit score; hard inquiries may impact it

Answer

In patient collections, propensity-to-pay tools may use soft inquiries, which don't affect credit scores, unlike hard inquiries from formal credit checks.

Question 3

A claim is denied because the rendering provider's NPI is not enrolled with the payer. What is the most effective resolution?

Accepted Answer

Enroll the provider with the payer and resubmit once credentialing is confirmed

Answer

Completing payer enrollment and credentialing for the rendering provider and resubmitting is the correct resolution for NPI-related denials.

Question 4

Which approach is considered a best practice for reducing bad debt in a hospital's self-pay accounts?

Accepted Answer

Screening patients for charity care eligibility and offering payment plans proactively

Answer

Early identification of charity care candidates and proactive payment plan offers reduces bad debt and improves patient relations.

Question 5

What does the term 'appeal level' refer to in the payer denial management process?

Accepted Answer

The sequential stages of the formal appeals process available to contest a denial

Answer

Appeal levels refer to the ordered stages (first-level, second-level, external review) through which a provider can formally contest a denial.

CRCR - Certified Revenue Cycle Representative Program Practice Test

CRCR - Certified Revenue Cycle Representative Program Practice Test

CRCR Account Follow-Up and Collections 5