CRCR CRCR - Certified Revenue Cycle Representative Program Claims Processing and Billing 4

Question 1

What is the primary purpose of a remittance advice (RA) in the revenue cycle?

Accepted Answer

To communicate the payer's adjudication decisions including payments, adjustments, and denials

Answer

The remittance advice details how each claim line was processed, including allowed amounts, contractual adjustments, patient responsibility, and denial reasons.

Question 2

Which of the following is an example of an ANSI reason code that indicates patient responsibility?

Accepted Answer

PR-1: Deductible amount

Answer

PR (Patient Responsibility) codes such as PR-1 identify amounts that the payer has determined are owed by the patient rather than the plan.

Question 3

A provider submits a claim within the timely filing deadline, but the payer denies it stating the deadline was missed. What documentation should the provider gather to appeal?

Accepted Answer

Proof of timely submission such as a clearinghouse acceptance report or certified mail receipt

Answer

To overturn a timely filing denial, the provider must submit documented evidence that the claim was received or transmitted within the required timeframe.

Question 4

Under HIPAA, what is the maximum number of days a payer generally has to acknowledge receipt of an electronic claim?

Accepted Answer

2 business days

Answer

HIPAA electronic transaction standards require trading partners to acknowledge receipt of an 837 transaction within 2 business days via a 999 or TA1 acknowledgment.

Question 5

A provider bills $500 for a service. The contracted rate is $300. The patient has a $50 copay. What is the contractual adjustment amount posted to the account?

Accepted Answer

$200

Answer

The contractual adjustment equals the billed charge minus the allowed amount: $500 − $300 = $200, which must be written off per the provider's contract.

CRCR - Certified Revenue Cycle Representative Program Practice Test

CRCR - Certified Revenue Cycle Representative Program Practice Test

CRCR CRCR - Certified Revenue Cycle Representative Program Claims Processing and Billing 4