CHAA - Certified Healthcare Access Associate Revenue Cycle Management 3 — Questions and Answers
Question 1: Which term describes the process of verifying that a payer will reimburse for a specific service before it is rendered?
- Concurrent review
- Prior authorization (Correct answer)
- Retrospective audit
- Coordination of benefits
Correct answer: Prior authorization
Prior authorization (also called pre-authorization or pre-certification) is the process of obtaining payer approval before delivering a service to confirm coverage and reimbursement, reducing the risk of claim denial.
Question 2: What is the term for the time limit a provider has to submit a claim to a payer after a service is rendered?
- Adjudication period
- Timely filing deadline (Correct answer)
- Grace period
- Remittance window
Correct answer: Timely filing deadline
Timely filing deadline refers to the contractually or legally defined window within which a provider must submit a claim. Missing this deadline is a common reason for claim denial that typically cannot be appealed.
Question 3: In the revenue cycle, what does 'accounts receivable' (A/R) represent?
- Money owed by the hospital to vendors
- Payments already posted to patient accounts
- Outstanding balances owed to the provider for services rendered (Correct answer)
- Insurance premiums collected in advance
Correct answer: Outstanding balances owed to the provider for services rendered
Accounts receivable represents money owed to the healthcare organization for services already provided but not yet paid. Monitoring A/R days is a key indicator of revenue cycle efficiency.
Question 4: Which step in the revenue cycle involves reviewing an Explanation of Benefits (EOB) and posting payments to patient accounts?
- Charge capture
- Payment posting (Correct answer)
- Utilization review
- Eligibility verification
Correct answer: Payment posting
Payment posting is the process of recording payments received from payers and patients into the billing system, using the EOB or Electronic Remittance Advice (ERA) to match payments to claims.
Question 5: What is the purpose of a 'write-off' in healthcare revenue cycle management?
- To transfer a balance to collections
- To adjust or remove a balance the provider has agreed not to collect (Correct answer)
- To resubmit a denied claim with corrections
- To increase a patient's financial responsibility
Correct answer: To adjust or remove a balance the provider has agreed not to collect
A write-off is an accounting adjustment that removes a balance from accounts receivable that the provider cannot or has contractually agreed not to collect, such as contractual adjustments with insurers or uncollectable bad debt.
Question 6: Which metric measures the average number of days it takes a healthcare organization to collect payment after a service is provided?
- Denial rate
- Days in accounts receivable (A/R days) (Correct answer)
- Net collection rate
- First-pass resolution rate
Correct answer: Days in accounts receivable (A/R days)
Days in accounts receivable (A/R days) measures the average time between service delivery and payment collection. A lower number indicates a more efficient billing and collections process.
CHAA - Certified Healthcare Access Associate Revenue Cycle Management 3
Which term describes the process of verifying that a payer will reimburse for a specific service before it is rendered?