CHAA - Certified Healthcare Access Associate Revenue Cycle Management 6 — Questions and Answers
Question 1: Which term describes the process of verifying that a patient's insurance policy covers the specific services to be rendered before care is provided?
- Pre-authorization
- Eligibility verification (Correct answer)
- Prior approval
- Benefits coordination
Correct answer: Eligibility verification
Eligibility verification confirms that a patient's insurance is active and that the planned services are covered under their policy before the visit occurs, reducing the risk of claim denials.
Question 2: What is the purpose of an Explanation of Benefits (EOB) in the revenue cycle?
- To inform the patient of their scheduled appointment
- To document the medical necessity of a procedure
- To detail how an insurance company processed a claim and what it will pay (Correct answer)
- To authorize a referral to a specialist
Correct answer: To detail how an insurance company processed a claim and what it will pay
An EOB is a statement from the insurer explaining how a claim was adjudicated, including the amount billed, the amount allowed, the insurer's payment, and the patient's responsibility.
Question 3: In revenue cycle management, what does 'days in accounts receivable' (AR days) measure?
- The number of days a patient occupies a hospital bed
- The average number of days it takes to collect payment after a service is rendered (Correct answer)
- The total dollar value of outstanding patient balances
- The number of days an authorization remains valid
Correct answer: The average number of days it takes to collect payment after a service is rendered
AR days is a key performance metric that measures the average time between a service being provided and payment being received, with a lower number indicating more efficient collections.
Question 4: Which action is the most appropriate first step when a claim is denied due to 'lack of medical necessity'?
- Write off the balance as a bad debt
- Rebill the claim to a secondary insurer
- Obtain and submit clinical documentation supporting the necessity of the service (Correct answer)
- Transfer the balance to the patient immediately
Correct answer: Obtain and submit clinical documentation supporting the necessity of the service
A medical necessity denial requires the provider to submit supporting clinical documentation, such as physician notes or treatment records, to demonstrate that the service was appropriate and warranted.
Question 5: What is the role of a chargemaster (charge description master) in the revenue cycle?
- It tracks patient appointment scheduling
- It serves as a comprehensive list of all billable services and their associated charges used by a facility (Correct answer)
- It records insurance contract negotiated rates
- It manages staff payroll and billing department budgets
Correct answer: It serves as a comprehensive list of all billable services and their associated charges used by a facility
The chargemaster is a facility's master list of every service, supply, and procedure it provides along with the standard charge for each, forming the foundation for claim generation.
Question 6: What is the significance of the 'timely filing' deadline in healthcare billing?
- It is the window within which a patient must pay their co-pay
- It is the maximum time a provider has to submit a claim to an insurer after the date of service (Correct answer)
- It refers to how quickly a patient's medical records must be updated
- It sets the deadline for completing discharge summaries
Correct answer: It is the maximum time a provider has to submit a claim to an insurer after the date of service
Payers impose timely filing limits — often ranging from 90 days to one year — within which a claim must be submitted after the service date; claims filed after this window are typically denied without recourse.
CHAA - Certified Healthcare Access Associate Revenue Cycle Management 6
Which term describes the process of verifying that a patient's insurance policy covers the specific services to be rendered before care is provided?