CRCR Part 4| 36 Questions with Answers 2023,100% CORRECT
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CRCR Part 4
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CRCR Part 4
CRCR Part 4| 36 Questions with Answers 2023
General Ledger Cash - CORRECT ANSWERSPetty cash used as payments for miscellaneous purchases
Electronic Funds Transfer (EFT) - CORRECT ANSWERSThe transfer of funds from payer to payee through the banking system. It is considered the quickest way...
General Ledger Cash - CORRECT ANSWERSPetty cash used as payments for
miscellaneous purchases
Electronic Funds Transfer (EFT) - CORRECT ANSWERSThe transfer of funds from
payer to payee through the banking system. It is considered the quickest way to
move money because it is possible to transfer funds between banks on the same
day.
Electronic Remittance Advice (ERA) - CORRECT ANSWERSA standardized
healthcare claim payment format used to electronically send third-party payment
details to healthcare providers.
ERA Level 1 - CORRECT ANSWERSElectronic receipt of 835 data only. An ERA is
received, the info is printed, and the printout is processed the same as a paper
remittance.
ERA Level 2 - CORRECT ANSWERSElectronic receipt of 835 dataset and electronic
data entry. ERA data is received and entered into the computer electronically,
then viewed in a terminal.
ERA Level 3 - CORRECT ANSWERSElectronic receipt, data entry, reconciliation,
posting, and closing of 835 data.
ERA Level 4 - CORRECT ANSWERSTotal automation of receipt, data entry,
payment posting, and adjustment processing of 835 data. Includes all of level 3
and linking of banking information to allow reconciliation of payments received
electronically though a non-bank network, with funds received electronically.
Credit Balances - CORRECT ANSWERSWhen payments and contractual
adjustments posted to an account exceed the overall total charges.
, CMS-838 - CORRECT ANSWERSMedicare form used to report all Medicare credit-
balance overpayment accounts on a quarterly basis.
Technical Denials - CORRECT ANSWERSType of health plan denial based on
missing or incomplete claim information.
Clinical Denials - CORRECT ANSWERSType of health plan denial associated with
the care or service provided.
Underpayment denials - CORRECT ANSWERSWhen the health plan pays less than
the agreed contract amount.
Pre-service denials - CORRECT ANSWERSAssociated with Physicians, Patient
Access, Financial Counselors, and Case Management. Examples include not
obtaining pre-auth, insurance benefits not verified, incorrect data entry.
Time-of-service Denials - CORRECT ANSWERSAssociated with Physicians, Patient
Access, Case Management, Clinical Service departments, and HIM.
Examples include New technology used without determining coverage, Charges
bundled or unbundled incorrectly, Patient acuity level changes but the type of
service not changed, admission notification not completed, or invalid coding
Post-Service Denials - CORRECT ANSWERSAssociated with the Clinical Service
departments, Patient Access, IT, and Patient Accounting
Examples include late charges, duplicate claims, and untimely filing.
Recovery Audit Contractors (RAC) - CORRECT ANSWERSMission is to protect
Medicare from fraudulent and abusive billing.
Beneficiary Appeal Type - CORRECT ANSWERSFiled by the Medicare beneficiary
who is dissatisfied with the government's claim determination.
Provider Appeal Type - CORRECT ANSWERSFiled by the provider. When the
amount in question is between $1,000 and $10,000, a provider may request a
hearing. If the amount is >$10k the provider may file the appeal with the Provider
Reimbursement Review Board.
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