CRCR cheatsheet

CRCR high-yield revenue-cycle drill

The rule

Clear the visit, capture the charge, post the remittance, and route the exception. You do not decide what the payer pays.

Next step

If a line will not balance or a required element is missing, hold and name the owner. Do not invent the field.

Never miss

  • Pre-service is identity, eligibility, authorization, and estimates.
  • A clean claim has the required data elements. It is not a payment promise.
  • MSP asks whether another payer is primary to Medicare.
  • An ABN is for expected Medicare noncoverage of a usually covered service, before the service.
  • A remittance must balance: charge equals paid plus adjustments plus patient responsibility.
  • Authorization denials go to access, not to a silent diagnosis rewrite.

Traps

  • Changing a diagnosis so the claim pays.
  • Blind contractual write-offs that hide underpayments.
  • Treating a generic waiver as an ABN.
  • Leaving patient class wrong after a status change.

Shortcuts

  • Route by remittance reason, not by who emailed last.
  • Age the AR by payer reason.
  • Status change means recapture charges under the new class.

Terms

  • Clean claim. A claim complete enough for the payer to process.
  • MSP. Medicare Secondary Payer. Screen whether another payer is primary.
  • ABN. Advance Beneficiary Notice of Noncoverage. Before the service, when Medicare is expected not to pay.
  • Charge capture. The documented service and the charged service must match.
  • Patient class. Inpatient, observation, outpatient, or ED. It must match the order.
  • 835. Electronic remittance. Post paid, contractual, and patient-responsibility lines.
  • COB. Coordination of benefits. Which plan is primary, secondary, tertiary.

Memory hooks

  • PRE-TOS-POST. Pre-service, time of service, post-service HFMA's CRCR unit order.
  • ID-ELIG-AUTH-EST. Identity, eligibility, authorization, estimate Financial clearance checklist.