CRCR Part 4 Flashcards

Questions and Answers

What is the definition of General Ledger Cash?

A type of bank account

Petty cash used as payments for miscellaneous purchases (correct)

Investment account

Funds used for major expense transactions

What does Electronic Funds Transfer (EFT) represent?

Transferring funds electronically through the banking system (correct)

Transferring cash physically between banks

Only for international transactions

A form of payment using checks

What is Electronic Remittance Advice (ERA) used for?

Sending check payments to providers

Payment receipts for health plans

Standardized electronic format to send payment details to healthcare providers (correct)

A method of filing taxes

What is the main function of ERA Level 1?

Electronic receipt of 835 data only. Signup and view all the answers

Describe ERA Level 2.

Electronic receipt of 835 dataset and electronic data entry. Signup and view all the answers

What does ERA Level 3 include?

Electronic receipt, data entry, reconciliation, posting, and closing of 835 data. Signup and view all the answers

What is the highest level of electronic remittance advice?

ERA Level 4 Signup and view all the answers

What are credit balances?

Payments and adjustments that exceed total charges Signup and view all the answers

What is CMS-838?

Medicare form used to report credit-balance overpayment accounts quarterly. Signup and view all the answers

What are technical denials?

Denials based on missing or incomplete claim information Signup and view all the answers

What characterizes clinical denials?

Denials focused on the care or service provided Signup and view all the answers

What do underpayment denials mean?

Less payment than the agreed contract amount Signup and view all the answers

What are pre-service denials associated with?

Patient access and financial counseling Signup and view all the answers

What is an example of a time-of-service denial?

New technology used without determining coverage Signup and view all the answers

What do post-service denials refer to?

Associated with clinical service departments and late charges Signup and view all the answers

What is the mission of Recovery Audit Contractors (RAC)?

To protect Medicare from fraudulent billing Signup and view all the answers

What is a beneficiary appeal type?

Filed by the Medicare beneficiary dissatisfied with claim determination Signup and view all the answers

Describe the provider appeal type.

Filed by the provider for disputed amounts between $1,000 and $10,000. Signup and view all the answers

What is the Medicare waiver of liability?

Medicare is liable if neither the beneficiary nor provider knew services were not covered. Signup and view all the answers

What are liens?

A claim against real or personal property that secures payment of a debt. Signup and view all the answers

What are agreement liens?

Filed by creditors to protect their interests under the UCC. Signup and view all the answers

What are judicial liens?

Liens placed when a creditor cannot collect through reasonable methods. Signup and view all the answers

What are statute liens?

Liens used to secure payment for back wages, back rent, or contractor payments. Signup and view all the answers

Study Notes

Financial Transactions

Electronic Funds Transfer (EFT) is the quickest way to move money, allowing same-day transfers between banks.
Electronic Remittance Advice (ERA) is a standardized format for sending third-party payment details to healthcare providers.

ERA Levels

ERA Level 1: Electronic receipt of 835 data only, printed and processed like a paper remittance.
ERA Level 2: Electronic receipt and data entry, viewed in a terminal.
ERA Level 3: Electronic receipt, data entry, reconciliation, posting, and closing of 835 data.
ERA Level 4: Total automation, including receipt, data entry, payment posting, and adjustment processing.

Credit Balances and Reporting

Credit balances occur when payments and contractual adjustments exceed total charges.
CMS-838 is the Medicare form used to report credit-balance overpayment accounts quarterly.

Denials

Technical denials: Missing or incomplete claim information.
Clinical denials: Associated with the care or service provided.
Underpayment denials: Health plan pays less than the agreed contract amount.
Pre-service denials: Examples include not obtaining pre-auth, incorrect data entry.
Time-of-service denials: Examples include new technology used without determining coverage, incorrect coding.
Post-service denials: Examples include late charges, duplicate claims, untimely filing.

Audits and Appeals

Recovery Audit Contractors (RAC) protect Medicare from fraudulent and abusive billing.
Beneficiary appeal type: Filed by the Medicare beneficiary dissatisfied with the government's claim determination.
Provider appeal type: Filed by the provider, with options for hearings or filing with the Provider Reimbursement Review Board.

Liens

Medicare Waiver of Liability: Medicare is liable for paying the claim if the beneficiary or provider didn't know the services were not covered.
Liens: A claim against real or personal property to secure payment of a debt or performance.
Agreement liens: Filed under the Uniform Commercial Code (UCC) to protect a security interest.
Judicial liens: Result from a creditor's inability to collect via reasonable means.
Statute liens: Four common types, including employee's lien, landlord's lien, materialman's lien, and tax lien.

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Test your knowledge with these flashcards from CRCR Part 4. The terms focus on key concepts like General Ledger Cash and Electronic Funds Transfer. Perfect for reinforcing your understanding of essential financial transactions.