Certified Revenue Cycle Representative (CRCR) Practice Exam

What occurs as a result of a denied claim for a healthcare provider?

1. The patient receives a full refund

2. The provider incurs rework and appeal costs

3. The claim is automatically resubmitted

4. The provider receives increased funding

The correct answer is: The provider incurs rework and appeal costs

When a claim is denied, the healthcare provider faces several challenges, and one of the primary consequences is that they incur rework and appeal costs. This situation typically arises because the denial means the provider will have to revisit the claim, investigate the reasons for the denial, and potentially gather additional information or documentation to support the claim's validity. This process often involves staff time, resources, and additional administrative efforts to successfully appeal the denial and get reimbursed. In the context of revenue cycle management, these denied claims can significantly impact the provider's financial performance, requiring time and effort to resolve, which detracts from the focus on other important tasks. Therefore, option B accurately reflects a direct and common outcome related to denied claims in the healthcare industry. This understanding underscores the importance of effective claims submission and management processes to minimize denials and their associated costs.