CHAA - Certified Healthcare Access Associate Revenue Cycle Management 4

Question 1

What is the primary purpose of a remittance advice (RA) in the revenue cycle?

Accepted Answer

To explain the payment determination made by a payer on a submitted claim

Answer

A remittance advice is a document sent by the payer alongside payment that details how each claim was adjudicated, including amounts paid, denied, or adjusted. It allows the provider to reconcile payments and identify discrepancies.

Question 2

Which metric measures the average number of days it takes a healthcare organization to collect payment after a service is rendered?

Accepted Answer

Days in accounts receivable (AR)

Answer

Days in accounts receivable (AR) is a key revenue cycle performance indicator that tracks how long it takes, on average, to collect payment from the date of service. A lower number generally indicates a healthier revenue cycle.

Question 3

During the revenue cycle, what is the role of coordination of benefits (COB)?

Accepted Answer

To determine which payer is primary when a patient has multiple insurance plans

Answer

Coordination of benefits (COB) is the process of determining the order in which multiple insurance plans pay a claim. The primary payer pays first, and the secondary payer may cover remaining eligible balances, preventing overpayment.

Question 4

What does a contractual adjustment represent in healthcare billing?

Accepted Answer

The difference between a provider's billed charges and the payer's allowed amount

Answer

A contractual adjustment is the amount written off because the provider has an agreement (contract) with the payer to accept a negotiated rate. The provider cannot bill the patient for this difference, which is known as balance billing prohibition.

Question 5

Which revenue cycle function is primarily responsible for verifying a patient's insurance eligibility and benefits prior to a service date?

Accepted Answer

Pre-registration and access services

Answer

Pre-registration and access services staff verify insurance eligibility and benefits before the patient arrives, ensuring accurate insurance information is on file. This reduces claim denials caused by coverage issues and improves point-of-service collections.

CHAA - Certified Healthcare Access Associate Practice Test

CHAA - Certified Healthcare Access Associate Practice Test

CHAA - Certified Healthcare Access Associate Revenue Cycle Management 4