Certified Revenue Cycle Representative (CRCR) Practice Exam

When primary payment is received, what should happen with the actual reimbursement?

1. Be compared to the expected reimbursement

2. Be recorded by Patient Accounting and the patient's account is closed

3. Be compared to the expected reimbursement, the remaining contractual adjustments are posted, and secondary claims are submitted

4. Trigger that the secondary claims can then be prepared

The correct answer is: Be compared to the expected reimbursement, the remaining contractual adjustments are posted, and secondary claims are submitted

The correct choice emphasizes the comprehensive steps that need to occur once the primary payment is received within the revenue cycle. When the primary payment is processed, it is not only a matter of acknowledging the amount received; it is essential to compare this figure against the expected reimbursement. This comparison allows for the identification of any discrepancies or adjustments that may be necessary. After this analysis, the remaining contractual adjustments, which are the differences between the charges and the primary payment received, need to be posted. This ensures the financial records accurately reflect the amount owed by the patient and the payer's contractual obligations. Only after this process is complete can secondary claims be prepared and submitted. This systematic approach makes sure that all financial interactions with payers are handled efficiently and accurately, maximizing revenue recovery and maintaining clear patient accounts. Overall, this diligent process helps ensure that the healthcare provider is compensated appropriately while also documenting the necessary adjustments and claims for future payments.