Certified Revenue Cycle Representative (CRCR) Practice Exam

How is a mis-posted contractual allowance typically resolved?

1. Using patient interviews for confirmation

2. Revising the billing form entirely

3. Comparing contract reimbursement rates against the correct calculations

4. Checking the patient's insurance history

The correct answer is: Comparing contract reimbursement rates against the correct calculations

Resolving a mis-posted contractual allowance involves ensuring that the correct financial adjustments are made based on the established terms of the contract. The approach that involves comparing contract reimbursement rates against the correct calculations is vital because it allows for an accurate assessment of what the contractual allowance should reflect. By reviewing the specific reimbursement rates outlined in contracts with insurers, healthcare providers can determine if there has been an error in posting the allowance. This process ensures that all adjustments properly align with the agreed-upon terms, allowing any discrepancies to be corrected efficiently. In contrast, other options like conducting patient interviews or checking insurance history may provide context or information, but they do not directly address the financial posting process or resolve issues with contractual allowances. Revising the billing form entirely might be needed in some cases, but it is not a targeted resolution tactic for a mis-posted allowance, as it does not involve validating the rates against the actual contract terms. Thus, comparing reimbursement rates against calculations directly addresses the root of the mis-posting.