CRCR CRCR - Certified Revenue Cycle Representative Program Account Follow-Up and Collections 5

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?

Accepted Answer

Advise the patient to contact their insurer for the EOB and place a short hold on the account while the dispute is investigated

Answer

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?

Accepted Answer

Provide the patient with an itemized statement showing dates of service, charges, and amounts applied by insurance

Answer

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?

Accepted Answer

The agreed payment amount, frequency, start date, and consequences for default, along with the patient's signature

Answer

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?

Accepted 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

Answer

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?

Accepted Answer

Contact the payer by phone or portal to confirm receipt, check processing status, and document the interaction

Answer

Proactive payer follow-up at defined intervals, with documentation of each contact, is the standard practice for claims lingering beyond normal processing timeframes.

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 5