CEHRS Clinical and Financial Reporting 4

Question 1

A practice's gross collection rate is 55% while its net collection rate is 96%. What does this discrepancy most likely indicate?

Accepted Answer

The practice has large contractual write-offs from payer contracts

Answer

The practice has significant uncollected patient balances

Answer

The billing staff is not submitting claims on time

Answer

The practice's fee schedule is set too low

Question 2

Which type of EHR report would help a practice comply with HEDIS (Healthcare Effectiveness Data and Information Set) measures?

Accepted Answer

Quality measure and clinical outcome reports

Answer

Accounts receivable aging report

Answer

Payroll expense summary

Answer

Equipment depreciation report

Question 3

A claim is submitted with CPT code 99213 but the documentation supports only CPT 99212. What is the most appropriate action?

Accepted Answer

Correct the code to 99212 and resubmit to reflect accurate documentation

Answer

Submit the claim as coded to maximize reimbursement

Answer

Add a modifier to justify the higher-level code

Answer

Void the claim and do not bill for the service

Question 4

In EHR financial reporting, 'payer mix' refers to:

Accepted Answer

The distribution of patients by insurance type (Medicare, Medicaid, commercial, self-pay)

Answer

The combination of CPT codes billed by a provider

Answer

The ratio of inpatient to outpatient claims

Answer

The number of claims submitted per provider

Question 5

Which SNOMED CT concept domain would be most appropriate for documenting a clinical finding such as 'pain in right knee' in an EHR?

Accepted Answer

Clinical finding domain

Answer

Procedure domain

Answer

Body structure domain

Answer

Pharmaceutical domain

Question 6

When reviewing a remittance advice, a CEHRS specialist sees reason code PR-1. What does this code indicate?

Accepted Answer

The patient is responsible for the deductible amount

Answer

The claim was denied due to duplicate submission

Answer

The service is not covered under the patient's plan

Answer

The provider is not in-network

Question 7

A hospital's clinical report shows a higher-than-expected 30-day readmission rate for heart failure patients. Which type of intervention would directly address this metric?

Accepted Answer

Implementing a post-discharge follow-up and care coordination program

Answer

Increasing the number of diagnostic codes per claim

Answer

Renegotiating payer contracts for higher reimbursement

Answer

Upgrading the EHR billing module