CRCR CRCR - Certified Revenue Cycle Representative Program Payment Posting and Reconciliation Questions and Answers 5

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?

Accepted Answer

Post the Medicare payment and bill the patient's primary insurer for the balance

Answer

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?

Accepted Answer

It documents a denial or no-payment decision requiring follow-up action

Answer

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?

Accepted Answer

Apply $1,400 to the claims and hold $100 as unapplied cash pending research

Answer

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:

Accepted Answer

A misapplied payment or misdirected payment

Answer

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?

Accepted Answer

Patient Responsibility (PR)

Answer

PR (Patient Responsibility) codes indicate amounts the patient owes, including deductibles, copays, and coinsurance.

CRCR - Certified Revenue Cycle Representative Program Practice Test