Certified Revenue Cycle Representative (CRCR) Practice Exam

Which option is NOT considered a type of denial?

1. Technical

2. Clinical

3. Underpayment

4. Contractual Adjustment

The correct answer is: Contractual Adjustment

Contractual adjustments represent amounts that are deducted from the billed charges based on terms agreed upon between the provider and the insurance company. These adjustments are part of the established agreements and are not classified as denials. Instead, they reflect the negotiated rates and are simply adjustments to the payment rather than an outright rejection of a claim. In contrast, other options refer to denials in the revenue cycle. Technical denials arise from errors in the claim's submission process, such as incorrect coding or missing information. Clinical denials are based on the medical necessity of the services provided, typically stemming from the provider documentation not meeting the payer's guidelines. Underpayment occurs when the insurer pays less than what is expected based on the agreed-upon rates or full charges, but it still relates to initial settlement disputes rather than acceptance or denial of claims. Overall, the characteristics and functions of contractual adjustments clearly distinguish them from the denial types that are related to claims rejection or dispute within the revenue cycle.