Certified Revenue Cycle Representative (CRCR) Practice Exam

What must hospitals do regarding Medicare credit balance accounts?

1. Adjust the patient billing process

2. Offer refunds to patients

3. Resolve discrepancies to avoid lost reimbursement costs

4. Cancel unpaid claims

The correct answer is: Resolve discrepancies to avoid lost reimbursement costs

Hospitals are required to manage Medicare credit balance accounts to ensure that they are in compliance with regulations and to maintain the integrity of their reimbursement processes. Addressing discrepancies in Medicare credit balances is crucial, as unresolved credit balances can lead to lost reimbursement costs. This means that if a hospital does not properly resolve these discrepancies, they may miss out on funds that are rightfully owed to them. In the context of Medicare, credit balances typically arise when a patient has paid more than the amount owed after adjudication of claims. To avoid potential audits, fines, and to ensure proper financial handling, hospitals must regularly review and reconcile these accounts. Resolving discrepancies enables them to correct overpayments or to issue refunds when applicable, thereby safeguarding their revenue cycle management and ensuring compliance with federal regulations. The other options, while relevant to billing and financial operations, do not capture the essential responsibility related to Medicare credit balance accounts. Adjusting the patient billing process is more about improving workflows rather than specifically addressing credit balances. Offering refunds to patients is a part of the process but does not directly reflect the broader necessity of resolving discrepancies. Cancelling unpaid claims does not directly address the issue of managing credit balances. Therefore, focusing on resolving discrepancies effectively addresses the critical aspect of managing Medicare credit