CRCR CRCR - Certified Revenue Cycle Representative Program Account Follow-Up and Collections 5 — Questions and Answers
Question 1: A patient disputes a balance, claiming they never received an Explanation of Benefits (EOB) from their insurer. What is the best response from the revenue cycle representative?
- Insist the patient pay immediately regardless of the dispute
- Advise the patient to contact their insurer for the EOB and place a short hold on the account while the dispute is investigated (Correct answer)
- Write off the balance to avoid conflict
- Forward the dispute to external collections
Correct answer: Advise the patient to contact their insurer for the EOB and place a short hold on the account while the dispute is investigated
Directing the patient to obtain their EOB and placing a temporary hold allows time to investigate without damaging the patient relationship or prematurely escalating the account.
Question 2: Which action best supports compliance when a patient requests validation of a debt being collected by a healthcare organization's in-house team?
- Refuse to provide information until payment is received
- Provide the patient with an itemized statement showing dates of service, charges, and amounts applied by insurance (Correct answer)
- Send only the total balance due without supporting detail
- Transfer the account to an external agency to handle the validation request
Correct answer: Provide the patient with an itemized statement showing dates of service, charges, and amounts applied by insurance
An itemized statement with dates of service, charges, and insurance payments is the standard method for validating a healthcare debt upon patient request.
Question 3: When a payment plan agreement is established with a self-pay patient, what is the most important element to document?
- The patient's employer information only
- The agreed payment amount, frequency, start date, and consequences for default, along with the patient's signature (Correct answer)
- The attending physician's name and NPI
- The patient's credit score
Correct answer: The agreed payment amount, frequency, start date, and consequences for default, along with the patient's signature
A complete payment plan agreement must capture payment terms, schedule, default consequences, and the patient's authorization to be enforceable and compliant.
Question 4: What is the significance of a payer's 'timely filing limit' in the context of account follow-up?
- It determines how long a patient has to dispute a bill
- It is the deadline by which a claim must be submitted to the payer or it will be denied and typically cannot be appealed (Correct answer)
- It sets the maximum interest rate on overdue balances
- It defines how long a provider must retain medical records
Correct answer: It is the deadline by which a claim must be submitted to the payer or it will be denied and typically cannot be appealed
Timely filing limits are payer-set deadlines for claim submission; missing the deadline typically results in a denial that cannot be reversed, causing permanent revenue loss.
Question 5: A claim has been in 'pending' status with a payer for 45 days with no remittance. What is the recommended follow-up action?
- Wait for the payer to respond without contacting them
- Contact the payer by phone or portal to confirm receipt, check processing status, and document the interaction (Correct answer)
- Immediately write off the claim as uncollectable
- Re-submit the claim without checking status first
Correct answer: Contact the payer by phone or portal to confirm receipt, check processing status, and document the interaction
Proactive payer follow-up at defined intervals, with documentation of each contact, is the standard practice for claims lingering beyond normal processing timeframes.
Question 6: Which of the following is an example of a 'soft' collections approach appropriate for early-stage patient balances?
- Referring the account to a collection agency
- Sending a friendly patient statement with payment options and financial assistance information (Correct answer)
- Reporting the balance to a credit bureau
- Issuing a formal demand letter with legal action warnings
Correct answer: Sending a friendly patient statement with payment options and financial assistance information
Early-stage collections should use patient-friendly communications that offer multiple payment options and inform patients of assistance programs before escalating to harder tactics.
Question 7: A revenue cycle manager notices that the Days in A/R has increased from 42 to 58 over the past quarter. Which root cause should be investigated first?
- Increase in inpatient volume
- Rise in claim denials, delayed submissions, or payment posting backlogs (Correct answer)
- Decrease in the number of self-pay patients
- Reduction in the number of providers on staff
Correct answer: Rise in claim denials, delayed submissions, or payment posting backlogs
An increase in Days in A/R typically signals upstream issues such as higher denial rates, late claim submissions, or a backlog in posting payments that slow cash collection.
CRCR CRCR - Certified Revenue Cycle Representative Program Account Follow-Up and Collections 5
A patient disputes a balance, claiming they never received an Explanation of Benefits (EOB) from their insurer.
What is the best response from the revenue cycle representative?