Certified Revenue Cycle Representative (CRCR) Practice Exam

If both of a patient's insurance plans are determined to pay as primary, what should the provider do?

1. Cancel the patient’s insurance policies

2. Determine the correct payer and notify the incorrect payer of the processing error

3. File a claim with both insurers simultaneously

4. Contact the patient for further instructions

The correct answer is: Determine the correct payer and notify the incorrect payer of the processing error

When both of a patient's insurance plans are identified as being potentially primary payers, it is important for the provider to first clarify which insurance policy should be billed. This is essential because double billing can lead to complications, including the denial of claims and potential issues with fraud. Determining the correct payer involves reviewing the specifics of each policy, as insurance policies often contain stipulations regarding coordination of benefits. Once the correct primary insurer is identified, notifying the incorrect payer about the processing error is vital to ensure that all parties are aware of the situation and can adjust their records accordingly. This step helps streamline the claims process and reduces delays in payment. Following this approach maintains compliance with insurance regulations and protects the patient from potential out-of-pocket expenses that could arise from improperly billed claims. Properly managing primary and secondary insurance plans is a critical aspect of revenue cycle management.