Revenue Cycle Management Flashcards
6 cards from real CBCS 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 the typical sequence of steps in the revenue cycle?
Answer: Pre-registration/scheduling → registration → charge capture → coding → claim submission → payment posting → AR follow-up → patient collections
The revenue cycle follows a logical sequence from appointment scheduling through final payment, encompassing all administrative and clinical functions related to capturing, managing, and collecting patient service revenue.
What is 'days in accounts receivable (AR)' and why is it important?
Answer: A financial metric measuring the average number of days it takes to collect payment after a service is rendered; lower is better for cash flow
Days in AR is calculated as: (Total AR / Average Daily Charges). It measures how quickly a practice collects revenue. Industry benchmarks vary by specialty but most practices aim for fewer than 40 days.
What is a charge master (CDM) and how does it relate to billing?
Answer: A comprehensive list of all services, procedures, supplies, and their associated charges used by a facility to generate patient bills and insurance claims
The charge master (CDM) is a healthcare facility's comprehensive price list containing every billable item (services, procedures, supplies, drugs) with associated CDM codes, revenue codes, CPT/HCPCS codes, and charge amounts.
What is a key performance indicator (KPI) commonly used to measure revenue cycle efficiency?
Answer: First-pass resolution rate (FPRR) — the percentage of claims paid on the first submission without denial or correction
First-pass resolution rate (FPRR) measures the percentage of claims that are paid on first submission. High-performing practices typically achieve 95%+ FPRR, indicating effective coding, eligibility verification, and clean claim processes.
What is patient financial counseling in the revenue cycle?
Answer: The process of informing patients of their financial responsibility, payment options, and available assistance programs before and after services are rendered
Patient financial counseling helps patients understand their insurance benefits, out-of-pocket costs, and available payment assistance options, improving collections and patient satisfaction while reducing bad debt.
What is the purpose of a write-off analysis in the revenue cycle?
Answer: To review and categorize adjustments and write-offs to ensure they are appropriate, authorized, and not masking underpayments or improper billing patterns
Write-off analysis examines adjustments to ensure contractual write-offs match payer contracts (detecting underpayments), non-contractual write-offs are authorized, and patterns don't indicate fraud or billing errors.