CHAA - Certified Healthcare Access Associate Revenue Cycle Management 2 — Questions and Answers
Question 1: What is the primary purpose of obtaining prior authorization in the revenue cycle?
- To verify a patient's demographic information before admission
- To confirm that a payer will cover a specific service before it is rendered (Correct answer)
- To collect the patient's copayment at the time of service
- To assign the correct diagnosis code to a procedure
Correct answer: To confirm that a payer will cover a specific service before it is rendered
Prior authorization is a payer requirement that must be obtained before certain services are performed. It confirms coverage eligibility and reduces the risk of claim denial due to medical necessity disputes.
Question 2: Which metric measures the average number of days it takes a healthcare organization to collect payment after a service is rendered?
- Denial rate
- Days in accounts receivable (A/R days) (Correct answer)
- Cost-to-collect ratio
- Net collection rate
Correct answer: Days in accounts receivable (A/R days)
Days in accounts receivable (A/R days) tracks how long outstanding balances remain unpaid. A lower number indicates a more efficient revenue cycle and faster reimbursement.
Question 3: What is the function of a remittance advice (RA) in the revenue cycle?
- It authorizes a provider to perform a clinical procedure
- It documents the patient's consent for treatment
- It explains how a payer processed a claim and what amount was paid or denied (Correct answer)
- It records the charges entered by clinical staff after a service
Correct answer: It explains how a payer processed a claim and what amount was paid or denied
A remittance advice is sent by the payer to the provider after processing a claim. It details payment amounts, adjustments, and denial reasons, allowing the billing team to reconcile accounts.
Question 4: When a patient has both a primary and a secondary insurance plan, which process determines the order in which plans pay?
- Charge capture
- Coordination of benefits (COB) (Correct answer)
- Utilization review
- Case mix analysis
Correct answer: Coordination of benefits (COB)
Coordination of benefits (COB) establishes which plan pays first (primary) and which pays second (secondary), preventing duplicate payment and ensuring the patient is not reimbursed more than 100% of the cost.
Question 5: A hospital writes off a balance because it is contractually prohibited from billing the patient for the difference between its charge and the payer's allowed amount. This is known as a:
- Bad debt write-off
- Contractual adjustment (Correct answer)
- Charity care adjustment
- Administrative denial
Correct answer: Contractual adjustment
A contractual adjustment reduces the billed charge to the payer-allowed amount as required by the provider's contract. Unlike bad debt, it is an expected and pre-agreed reduction, not an uncollectible balance.
Question 6: Which step in the revenue cycle involves verifying that a patient's insurance is active and that the provider is in-network before the date of service?
- Claims adjudication
- Eligibility and benefits verification (Correct answer)
- Utilization management
- Payment posting
Correct answer: Eligibility and benefits verification
Eligibility and benefits verification confirms that the patient's coverage is active, identifies the plan's in-network status, and determines cost-sharing responsibilities such as deductibles and copays before service is delivered.
CHAA - Certified Healthcare Access Associate Revenue Cycle Management 2
What is the primary purpose of obtaining prior authorization in the revenue cycle?