CHAA - Certified Healthcare Access Associate Revenue Cycle Management 5

Question 1

What is the primary purpose of prior authorization in the revenue cycle?

Accepted Answer

To obtain payer approval before delivering certain services or procedures

Answer

Prior authorization requires the provider to obtain approval from the payer before rendering specific services. Without it, the payer may deny the claim entirely, making it a critical revenue cycle step that protects reimbursement.

Question 2

What does the metric 'days in accounts receivable' (A/R days) measure?

Accepted Answer

The average number of days it takes to collect payment after a service is rendered

Answer

Days in A/R is a key revenue cycle KPI that reflects how efficiently a provider collects payments. A lower number indicates faster collections and healthier cash flow.

Question 3

What is the purpose of 'claim scrubbing' before submission to a payer?

Accepted Answer

To verify that claims meet payer-specific formatting and coding requirements before submission

Answer

Claim scrubbing uses automated edits to catch errors—such as missing modifiers, invalid codes, or mismatched data—before a claim reaches the payer, reducing rejections and accelerating payment.

Question 4

What is the key difference between a claim rejection and a claim denial?

Accepted Answer

A rejection is returned before processing; a denial means the claim was processed but payment was refused

Answer

A rejected claim never enters the payer's adjudication system—it is returned due to technical errors. A denied claim was fully processed but the payer determined it would not be paid, often requiring an appeal.

Question 5

What is the primary purpose of an Explanation of Benefits (EOB) in the revenue cycle?

Accepted Answer

To detail how the payer adjudicated a claim and what patient financial responsibility remains

Answer

The EOB is sent by the payer to both the provider and the patient after claim adjudication. It shows the billed amount, allowed amount, payer payment, and any remaining balance owed by the patient, driving the final billing step.

CHAA - Certified Healthcare Access Associate Practice Test

CHAA - Certified Healthcare Access Associate Practice Test

CHAA - Certified Healthcare Access Associate Revenue Cycle Management 5