Certified Revenue Cycle Representative (CRCR) Practice Exam

How is a mis-posted contractual allowance typically resolved?

1. By adjusting the patient's balance directly

2. By comparing the contract reimbursement rates with the contract on the admittance advice

3. By contacting the patient's insurance provider for clarification

4. By reviewing payment histories and denying future claims

The correct answer is: By comparing the contract reimbursement rates with the contract on the admittance advice

A mis-posted contractual allowance is resolved by comparing the contract reimbursement rates with the contract on the admittance advice. This process is crucial because it involves verifying that the amount posted aligns with what was agreed upon in the payer contract. When a contractual allowance is mis-posted, it often means that the organization did not properly account for the agreed-upon discounts or allowances as dictated by the payer’s contract. By examining the reimbursement rates stated in the contract against what is shown in the admittance advice, discrepancies can be identified and rectified. This detailed comparison helps ensure that the correct financial adjustments are made to the patient’s account and the facility’s records, allowing for accurate financial reporting and compliance with contractual obligations. In contrast, other options do not address the root cause of the mis-posting effectively. Adjusting the patient's balance directly may not resolve discrepancies if the underlying information is incorrect. Contacting the insurance provider for clarification might help in some cases, but does not directly fix the posting error itself. Reviewing payment histories and denying future claims is more punitive and does not actively resolve the mis-posting at hand. Thus, the most direct and effective approach is to compare the contract reimbursement rates with the contract on the admittance advice.