Certified Revenue Cycle Representative (CRCR) Practice Exam

What term encompasses all activities required to send a request for payment to a third-party health plan?

1. Third-party invoicing

2. Account resolution

3. Claims processing

4. Billing

The correct answer is: Claims processing

The term that encompasses all activities required to send a request for payment to a third-party health plan is claims processing. Claims processing involves a systematic handling of various components necessary for submitting a claim, including the preparation, submission, and follow-up of claims to ensure that the healthcare provider receives payment for their services. During claims processing, healthcare organizations compile necessary documentation, verify patient information, check for coverage eligibility, and ensure that the services rendered are properly coded according to the payer's guidelines. This comprehensive approach includes addressing any potential discrepancies that may arise during the review by the third-party payer, making it a critical stage in the revenue cycle. While the other terms listed may relate to aspects of the overall billing process, claims processing specifically refers to the activity of managing and submitting requests for payment to health plans and ensuring those claims are tracked and followed up on until payment is received.