Revenue Cycle Management Flashcards
6 cards from real AAPC practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 6 Revenue Cycle Management flashcards as text
What is 'charge capture' in the revenue cycle?
Answer: The process of recording all billable services provided to a patient
Charge capture is the process of documenting all services rendered so they can be billed accurately to the payer.
What is the primary goal of a denial management process?
Answer: To identify, appeal, and prevent claim denials to maximize reimbursement
Denial management involves analyzing denial patterns, appealing wrongful denials, and implementing process improvements to reduce future denials.
What is the role of a clearinghouse in medical billing?
Answer: It acts as an intermediary that scrubs and transmits claims between providers and payers
A clearinghouse receives claims from providers, checks them for errors, and routes them electronically to the appropriate payers.
What does an 'accounts receivable aging report' track?
Answer: Outstanding balances categorized by how long they have been unpaid
AR aging reports categorize outstanding claims by time intervals (0-30, 31-60, 61-90, 90+ days) to prioritize collection efforts.
What is the purpose of obtaining prior authorization before a medical service?
Answer: To get advance approval from the payer that the service is medically necessary and covered
Prior authorization is a payer requirement to approve certain services before they are rendered, ensuring coverage and reducing claim denials.
In billing, 'coordination of benefits' (COB) refers to:
Answer: The process of determining which payer is primary and secondary when a patient has multiple insurance plans
COB determines the order in which multiple insurance plans pay claims to ensure the combined payment does not exceed the total charges.