CHAA - Certified Healthcare Access Associate Revenue Cycle Management 6

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?

Accepted Answer

Eligibility verification

Answer

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?

Accepted Answer

To detail how an insurance company processed a claim and what it will pay

Answer

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?

Accepted Answer

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

Answer

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'?

Accepted Answer

Obtain and submit clinical documentation supporting the necessity of the service

Answer

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?

Accepted Answer

It serves as a comprehensive list of all billable services and their associated charges used by a facility

Answer

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.

CHAA - Certified Healthcare Access Associate Practice Test

CHAA - Certified Healthcare Access Associate Practice Test

CHAA - Certified Healthcare Access Associate Revenue Cycle Management 6