CRCR CRCR - Certified Revenue Cycle Representative Program Payment Posting and Reconciliation Questions and Answers 5 — Questions and Answers
Question 1: A Medicare remittance shows a claim was paid at a lower rate due to a Medicare Secondary Payer (MSP) adjustment. What is the correct posting action?
- Post the full billed charge as the payment
- Post the Medicare payment and create a balance for the primary insurer
- Post the Medicare payment and bill the patient's primary insurer for the balance (Correct answer)
- Write off the entire claim as a Medicare adjustment
Correct answer: Post the Medicare payment and bill the patient's primary insurer for the balance
When Medicare is secondary, the primary insurer's balance must be billed for the remaining coordination of benefits amount.
Question 2: What is the purpose of a 'zero-pay EOB' in the payment posting process?
- It confirms the patient owes nothing on the account
- It documents a denial or no-payment decision requiring follow-up action (Correct answer)
- It records a contractual adjustment equal to the full charge
- It indicates the claim was paid via capitation
Correct answer: It documents a denial or no-payment decision requiring follow-up action
A zero-pay EOB means the payer processed the claim but issued no payment, typically due to a denial that requires follow-up.
Question 3: A provider receives a payment for $1,500 but the EOB lists two claims totaling $1,400. How should the $100 difference be handled?
- Post $1,500 split evenly across both claims
- Apply $1,400 to the claims and hold $100 as unapplied cash pending research (Correct answer)
- Write off $100 as an overpayment adjustment
- Refund $100 to the payer immediately
Correct answer: Apply $1,400 to the claims and hold $100 as unapplied cash pending research
The $100 overage should be held as unapplied cash until the source claim is identified rather than arbitrarily allocated.
Question 4: When a payer applies a payment to the wrong patient's account due to a data entry error, this is called:
- A contractual adjustment error
- A misapplied payment or misdirected payment (Correct answer)
- A coordination of benefits error
- A write-off discrepancy
Correct answer: A misapplied payment or misdirected payment
A misapplied or misdirected payment occurs when funds are posted to the wrong patient account and must be transferred.
Question 5: Which adjustment code category on an ERA indicates that the reduction is due to the patient not meeting their deductible?
- Contractual Obligation (CO)
- Patient Responsibility (PR) (Correct answer)
- Other Adjustment (OA)
- Payer Initiated Reduction (PI)
Correct answer: Patient Responsibility (PR)
PR (Patient Responsibility) codes indicate amounts the patient owes, including deductibles, copays, and coinsurance.
Question 6: A hospital's accounts receivable team discovers that 50 claims were posted with the wrong payer ID, resulting in incorrect contract adjustments. What is the correct resolution?
- Leave the postings and manually adjust the patient balances
- Reverse all affected postings, correct the payer ID, and repost with correct contractual adjustments (Correct answer)
- Submit appeals on all 50 claims to the payer
- Write off the adjustment differences as miscellaneous
Correct answer: Reverse all affected postings, correct the payer ID, and repost with correct contractual adjustments
Incorrect payer ID postings must be reversed and reposted with the correct payer information to ensure accurate contractual adjustments.
Question 7: What is the primary reason healthcare organizations perform a monthly accounts receivable (A/R) reconciliation to the general ledger?
- To identify patients who require payment plans
- To ensure financial statements accurately reflect outstanding receivables and catch posting errors (Correct answer)
- To calculate provider productivity bonuses
- To generate claims for secondary insurance billing
Correct answer: To ensure financial statements accurately reflect outstanding receivables and catch posting errors
Monthly A/R-to-general-ledger reconciliation ensures the integrity of financial reporting and surfaces any discrepancies from posting errors.
CRCR CRCR - Certified Revenue Cycle Representative Program Payment Posting and Reconciliation Questions and Answers 5
A Medicare remittance shows a claim was paid at a lower rate due to a Medicare Secondary Payer (MSP) adjustment.
What is the correct posting action?