CHAA - Certified Healthcare Access Associate Revenue Cycle Management 3

Question 1

Which term describes the process of verifying that a payer will reimburse for a specific service before it is rendered?

Accepted Answer

Prior authorization

Answer

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?

Accepted Answer

Timely filing deadline

Answer

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?

Accepted Answer

Outstanding balances owed to the provider for services rendered

Answer

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?

Accepted Answer

Payment posting

Answer

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?

Accepted Answer

To adjust or remove a balance the provider has agreed not to collect

Answer

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.

CHAA - Certified Healthcare Access Associate Practice Test

CHAA - Certified Healthcare Access Associate Practice Test

CHAA - Certified Healthcare Access Associate Revenue Cycle Management 3