Certified Revenue Cycle Representative (CRCR) Practice Exam

What is NOT a typical charge master problem that can result in a denial?

1. Does not include required modifiers

2. Errors in coding for services

3. Incorrect patient demographic information

4. Overlapping service dates

The correct answer is: Does not include required modifiers

The aspect that is not typically a charge master problem associated with denials is the inclusion of required modifiers. Charge master issues usually involve inaccuracies in the data submitted by the charge master itself, such as incorrect coding, demographic errors, or overlapping service dates, all of which can lead to a claim denial from payers. In healthcare billing, required modifiers provide additional information about the service rendered, further clarifying the context to the payer. While their absence might complicate a claim or potentially lead to misunderstandings in billing, it is not inherently categorized as a charge master problem. Charge master problems generally focus on direct errors within the charge master data itself, such as service codes and patient information misalignment. Therefore, options that deal specifically with charge master problems—like errors in coding (which can affect how services are billed), incorrect patient demographic information (which is crucial for proper claim processing), and overlapping service dates (which may indicate billing discrepancies)—are typical issues that can lead to denials. Overall, the relationship between modifiers and the charge master suggests that while they are important for accurate billing practice, their absence does not fit squarely within the typical framework of charge master issues leading to denials.