Certified Revenue Cycle Representative (CRCR) Practice Exam

What do large adjustments in claims require?

1. Patient consent

2. Manager-level approval

3. Board review

4. Internal audit confirmation

The correct answer is: Manager-level approval

Large adjustments in claims typically require manager-level approval due to the potential financial impact and the need for oversight in revenue cycle management. When a significant adjustment is made to a claim, it can reflect changes in billing amounts, discounts, or write-offs that affect the healthcare organization's revenue. Manager-level approval ensures that these adjustments are justified, properly documented, and align with the organization's policies and procedures. This level of scrutiny helps to minimize errors and fraudulent activities while maintaining compliance with regulations and payer requirements. It also reinforces accountability within the revenue cycle team, ensuring that adjustments are made responsibly and with a clear understanding of their implications on the organization's financial health. While patient consent may be necessary in certain contexts, such as when adjusting a patient’s balance or setting up a payment plan, it is not universally required for all adjustments. A board review may be seen in cases of substantial financial decisions but is not standard practice for typical claim adjustments. An internal audit confirmation could relate to ongoing quality assurance or compliance checks but is not a prerequisite for adjusting a claim in the typical revenue cycle process.