CRCR Claims Processing and Reimbursement 5

Question 1

A claim edit flags a procedure code as requiring an assistant surgeon modifier, but none was billed. What type of edit is this?

Accepted Answer

Assistant-at-surgery edit

Answer

Assistant-at-surgery edits identify procedures where Medicare's policy allows or requires an assistant surgeon and verify the appropriate modifier is present.

Question 2

What does the term 'accounts receivable (A/R) days' measure in revenue cycle management?

Accepted Answer

The average number of days it takes to collect payment after a service is rendered

Answer

A/R days is a key performance metric that measures how efficiently a provider collects revenue after services are delivered.

Question 3

A provider receives a Remittance Advice (RA) showing claim adjustment reason code (CARC) 97. What does this indicate?

Accepted Answer

The benefit for this service is included in the payment/allowance for another service

Answer

CARC 97 means the payment for one service is bundled into the payment for another service, indicating a bundling or inclusive adjustment.

Question 4

Which of the following is an example of an advance beneficiary notice (ABN) situation?

Accepted Answer

A provider believes Medicare may deny a routine colonoscopy as not medically necessary

Answer

An ABN must be given to Medicare beneficiaries before providing a service that Medicare may deny, allowing the patient to decide whether to proceed and accept financial responsibility.

Question 5

What is the significance of the 'clean claim' definition in payer contracts?

Accepted Answer

It establishes the timeframe within which a payer must adjudicate the claim once received

Answer

Most state prompt-pay laws and payer contracts tie adjudication timelines to receipt of a clean claim, making the definition critical for collections and appeals.

CRCR - Certified Revenue Cycle Representative Program Practice Test

CRCR - Certified Revenue Cycle Representative Program Practice Test

CRCR Claims Processing and Reimbursement 5