Certified Revenue Cycle Representative (CRCR) Practice Exam

Maintaining routine contact with the health plan or liability payer is primarily the responsibility of:

1. Patient Accounts

2. Managed Care Contract Staff

3. HIM staff

4. Case Management

The correct answer is: Case Management

Maintaining routine contact with health plans or liability payers is primarily the responsibility of Case Management. This role focuses on ensuring that patients receive the appropriate care while navigating the complexities of insurance and reimbursement. Case managers act as a bridge between patients, providers, and payers, coordinating care and addressing any issues that may arise during the reimbursement process. They are knowledgeable about various health plans and can effectively communicate with payers to ensure that claims are processed efficiently. This responsibility is crucial for minimizing delays in payment and ensuring that patients' care aligns with their insurance coverage. In contrast, Patient Accounts typically handle billing and account receivables, focusing more on the financial aspects rather than payer communication. Managed Care Contract Staff primarily deal with negotiating and administering contracts, while HIM staff focus on the management of health information and documentation requirements. Thus, while all these roles are important to the overall revenue cycle, the routine contact with payers is a key function of Case Management.