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2024 HFMA CRCR Part 1 Latest Questions With Complete Grade A Answers

2024 HFMA CRCR Part 1 Latest Questions With Complete Grade A Answers

1. Describe the paper and electronic claims flow process.
Answer:
1. Electronic Claim Submission= EDI claims forwarded to either directly or via EDI
clearing house/ vendor.
2. Claims Verification= Clearinghouse specifications and insurance company requirements used to validate transmitted claims.
3. Rejected Claims = Claims not meeting requirements returned via clearinghouse
error report.
4. Accepted claims= sent to insurance company for provider ID verification.
5. Providers are responsible for verification of EDI claims receipts.
6.Accepted /rejected claims must be reviewed and validated against transmittal
records daily.
2. Describe the purpose of the 835 and 837 EDI transactions.
Answer: EDI transactions include the 837 and 835 transactions.
The 837 EDI transaction is used to submit healthcare claim billing information,
encounter information, or both.It can be sent from providers of healthcare services
to payers, either directly or via intermediary billers and claims clearinghouses.It can
also be used to transmit healthcare claims and billing payment information between
payers with different payment responsibilities where coordination of benefits is
required or between payers and regulatory agencies to monitor the rendering,
billing, and/or payment of healthcare services within a specific healthcare/insurance
industry segment.
The 835 EDI transaction can be used to make a payment, send an Explanation of
Benefits(EOB) remittance advice, or make a payment and send an EOB remittance
advice only from a health insurer to a healthcare provider either directly or via a
financial institution.
3. Who are the typical revenue cycle team members?
Answer: Typical revenue cycle team members include the following:
1) Access management
2) Case management
3) Managed care contracting coordinator
4) Patient care representatives
5) CDM manager
6) Revenue integrity leader
7) Ancillary services
8) ED
9) Health information management
10) Patient financial services
11) Decision support
12) Finance and accounting (CFO)
13) Compliance
14) Information technology

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Choose quality study materials for nursing schools to ensure success in your studies and future career.

"Welcome to ExamNavigator - your perfect study assistant! Here you will find cheat sheets, study materials, exams, quizzes, tests, and notes to prepare for exams and study successfully. Our store offers a wide selection of materials on various subjects and difficulty levels, created by experienced teachers and checked for quality. Our cheat sheets are an easy and quick way to remember key points and definitions. And our study materials, tests, and quizzes will help you absorb the material and prepare for exams. Our store also has notes and lecture summaries that will help you save time and make the learning process more efficient.

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2024 HFMA CRCP ( Certified Revenue Cycle Representative) ( HFMA CRCP Version 1- 4 + Study Guide ) New Full Questions and Answers ( Included ) 100% Correct
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