CRCR CRCR - Certified Revenue Cycle Representative Program Account Follow-Up and Collections 4

Question 1

A claim is denied because the patient's insurance coverage was terminated on the date of service. What is the best course of action?

Accepted Answer

Verify eligibility retroactively, identify any active coverage, and re-bill or move to self-pay accordingly

Answer

When coverage is denied due to termination, staff should retroactively verify eligibility, check for other active insurance, and either re-bill the correct payer or convert to self-pay.

Question 2

Which of the following best describes a 'hardship write-off' in the context of healthcare collections?

Accepted Answer

A reduction or elimination of patient balance based on demonstrated financial inability to pay

Answer

A hardship write-off is granted when a patient demonstrates documented financial inability to pay, often after completing a financial assistance application.

Question 3

What is the primary risk of placing an account with an external collection agency without first exhausting internal collection efforts?

Accepted Answer

The patient relationship may be unnecessarily damaged and revenue may be lost to agency fees

Answer

Premature placement with an external agency damages patient relationships and reduces net recovery because agencies retain a percentage of collected amounts.

Question 4

Under HIPAA, which information may a healthcare organization share with a collection agency working on its behalf?

Accepted Answer

The minimum necessary protected health information (PHI) required to perform the collection activity

Answer

HIPAA's minimum necessary standard permits sharing only the PHI required for the collection agency to perform its function as a business associate.

Question 5

A payer issues a recoupment notice stating it will offset future payments to recover an overpayment made 18 months ago. What should the revenue cycle team do first?

Accepted Answer

Review the original claim and remittance to determine if the overpayment is valid before accepting or disputing

Answer

Before accepting a recoupment, the team should audit the original claim and remittance to confirm whether the overpayment actually occurred and whether the amount is correct.

CRCR - Certified Revenue Cycle Representative Program Practice Test

CRCR - Certified Revenue Cycle Representative Program Practice Test

CRCR CRCR - Certified Revenue Cycle Representative Program Account Follow-Up and Collections 4