Revenue Cycle Management Flashcards
7 cards from real AHIMA practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Revenue Cycle Management flashcards as text
Which claim form is required for professional/physician billing to Medicare?
Answer: CMS-1500
The CMS-1500 is the standard claim form used by non-institutional providers, including physicians, for professional billing to Medicare.
What is the primary purpose of a Remittance Advice (RA)?
Answer: To explain payments and adjustments made by the payer
A Remittance Advice details how a payer processed and paid (or denied) a claim, including adjustment reason codes and payment amounts.
A denial with CARC code CO-4 typically indicates:
Answer: The procedure code is inconsistent with the modifier used
CO-4 means the procedure code is inconsistent with the modifier used, or a required modifier is absent.
What is the Medicare timely filing limit for initial claim submission?
Answer: 12 months (1 year) from date of service
Medicare requires claims to be filed within one calendar year (12 months) from the date of service.
In denial management, what does it mean to 'work' a denial?
Answer: Investigating the denial reason and taking corrective action to resolve it
Working a denial involves analyzing the reason code, gathering supporting documentation, and submitting a corrected claim or formal appeal.
Which KPI measures the average number of days to collect payment after service delivery?
Answer: Days in Accounts Receivable (AR)
Days in AR measures the average elapsed time between service delivery and receipt of payment, indicating collection efficiency.
Which HIPAA transaction set is used to transmit an electronic remittance advice (ERA)?
Answer: HIPAA 835
The HIPAA 835 transaction is the electronic remittance advice used by payers to communicate payment details and adjustments to providers.