Certified Revenue Cycle Representative (CRCR) Practice Exam

Which statement regarding credit balances is false?

1. A small credit policy should be matched by a similar policy for small debit balances.

2. Tracking reports should be developed to identify internal charge credits versus external charge credits.

3. Hospital generated statements should be sent to patients regarding small credit balances.

4. There are no CMS hospital compliance requirements regarding credit balances.

The correct answer is: There are no CMS hospital compliance requirements regarding credit balances.

The statement that there are no CMS hospital compliance requirements regarding credit balances is indeed incorrect because it overlooks the specific regulations that govern how hospitals must manage credit balances. The Centers for Medicare & Medicaid Services (CMS) has established guidelines that require healthcare providers to manage credit balances effectively, ensuring that any excess payments are returned promptly to the appropriate payer, be it a patient or an insurance provider. This compliance requirement is put in place to maintain the integrity of billing practices and to prevent potential fraud. On the other hand, a small credit policy should align with a similar policy for small debit balances, emphasizing the importance of consistent practices in account management. Developing tracking reports is crucial for distinguishing between internal charge credits, such as those generated by the facility itself, and external charge credits, which could be linked to payer adjustments or refunds. Sending hospital-generated statements to patients for small credit balances promotes transparency and good customer service, ensuring patients are informed about any amounts owed or credited to them.