AAPC Revenue Cycle Management 2 — Questions and Answers
Question 1: What is 'charge capture' in the revenue cycle?
- The process of collecting co-pays at check-in
- The process of recording all billable services provided to a patient (Correct answer)
- Submitting claims electronically
- Verifying insurance eligibility
Correct 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.
Question 2: What is the primary goal of a denial management process?
- To increase patient co-pays
- To identify, appeal, and prevent claim denials to maximize reimbursement (Correct answer)
- To write off all denied claims
- To cancel patient accounts
Correct 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.
Question 3: What is the role of a clearinghouse in medical billing?
- It provides medical coding education
- It acts as an intermediary that scrubs and transmits claims between providers and payers (Correct answer)
- It processes patient payments directly
- It provides credentialing services
Correct 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.
Question 4: What does an 'accounts receivable aging report' track?
- The age of medical equipment
- Outstanding balances categorized by how long they have been unpaid (Correct answer)
- Patient demographics
- Provider scheduling
Correct 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.
Question 5: What is the purpose of obtaining prior authorization before a medical service?
- To schedule the patient faster
- To get advance approval from the payer that the service is medically necessary and covered (Correct answer)
- To verify the provider's credentials
- To post the payment in advance
Correct 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.
Question 6: In billing, 'coordination of benefits' (COB) refers to:
- Scheduling multiple appointments
- The process of determining which payer is primary and secondary when a patient has multiple insurance plans (Correct answer)
- Collecting co-pays from patients
- Filing appeals for denied claims
Correct 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.
AAPC Revenue Cycle Management 2
What is 'charge capture' in the revenue cycle?