Certified Revenue Cycle Representative (CRCR) Practice Exam

What does the claims processing contractor need to do when improper payments are identified as overpayments?

1. Assume legal responsibility for repaying the overage amount

2. Make recovery of the overpayment a top processing priority

3. Send a demand letter to the provider to recover the overpayment amount

4. Conduct an audit of all the affected provider's claims within the past twelve months

The correct answer is: Send a demand letter to the provider to recover the overpayment amount

When a claims processing contractor identifies improper payments classified as overpayments, the appropriate action is to send a demand letter to the provider to recover the overpayment amount. This process is a standard procedure, as it formally alerts the provider about the overpayment and initiates the process for recovery. The demand letter outlines the details of the overpayment, including the reason for the overpayment and the amount to be repaid. This approach ensures clear communication with the provider regarding the overpayment and sets the stage for resolution. It allows providers to understand their obligation to return the funds and gives them a chance to appeal or discuss the matter. Following this step is crucial, as it provides a documented basis for further actions if necessary. In contrast, assuming legal responsibility for repaying the overage would be inappropriate for the contractor, as they are not the ones who received the payment. Making recovery a top priority is important, but the initial step to begin this process is sending that demand letter. Conducting an audit of all the affected claims may be a next step if there are repeated issues or systemic problems, but it is not the immediate action taken upon identification of an overpayment.