AHIMA Revenue Cycle Management

Question 1

What is revenue cycle management in healthcare?

Accepted Answer

The financial process tracking patient service from registration through final payment

Answer

RCM encompasses the entire financial lifecycle: patient registration, insurance verification, coding, claim submission, payment posting, and collections.

Question 2

What is prior authorization?

Accepted Answer

Approval from an insurance company required before certain services are provided

Answer

Prior authorization requires providers to obtain insurance company approval before delivering specific services, ensuring medical necessity and coverage.

Question 3

What is a claim denial?

Accepted Answer

An insurance company's refusal to pay for a submitted healthcare claim

Answer

Claim denials occur when insurers refuse payment due to errors, lack of authorization, non-covered services, or insufficient documentation.

Question 4

What is accounts receivable in healthcare?

Accepted Answer

Money owed to the healthcare organization for services already provided

Answer

Accounts receivable represents outstanding payments for services rendered, tracked by age (30, 60, 90+ days) to monitor collection efficiency.

Question 5

What is the chargemaster?

Accepted Answer

A comprehensive listing of all billable items and their prices used by a healthcare facility

Answer

The chargemaster (charge description master) is a hospital's master price list for all services, procedures, supplies, and drugs used for billing purposes.

(AHIMA) American Health Information Management Association Practice Test

(AHIMA) American Health Information Management Association Practice Test

AHIMA Revenue Cycle Management