Certified Revenue Cycle Representative (CRCR) Practice Exam

What should be the first step in appealing a denied claim?

1. Consult with a lawyer

2. Review the denial reason and the payer's policy

3. Resubmit the claim immediately

4. Contact the patient for assistance

The correct answer is: Review the denial reason and the payer's policy

The first step in appealing a denied claim is to review the denial reason and the payer's policy. This step is crucial because it allows you to understand the specific reasons behind the denial. By examining the denial details, you can identify potential errors or missing information in the original claim submission. In addition, reviewing the payer's policy ensures that you are aware of the guidelines and criteria that the payer uses to evaluate claims. This knowledge is essential for crafting an effective appeal that addresses the specific issues raised by the payer, increasing the likelihood of a successful resolution. Understanding the denial fully empowers the appeals process, enabling you to correct any mistakes and provide additional documentation if necessary. Other options, such as consulting with a lawyer, resubmitting the claim immediately, or contacting the patient for assistance, may distract from the structured approach needed for a successful appeal. While these actions could be relevant at later stages, the foundation of a solid appeal lies in thoroughly understanding why the claim was denied in the first place.