CHAA - Certified Healthcare Access Associate Revenue Cycle Management 7 — Questions and Answers
Question 1: What is the term for the process of verifying that a patient's insurance policy is active and covers the services to be rendered?
- Eligibility verification (Correct answer)
- Prior authorization
- Charge capture
- Claims adjudication
Correct answer: Eligibility verification
Eligibility verification confirms that a patient's insurance coverage is active and that the planned services are covered benefits under the policy, reducing the risk of claim denials due to inactive or insufficient coverage.
Question 2: Which term describes the process by which an insurer reviews a submitted claim and determines the payment amount?
- Utilization review
- Claims adjudication (Correct answer)
- Remittance posting
- Charge capture
Correct answer: Claims adjudication
Claims adjudication is the process insurers use to evaluate submitted claims, apply policy benefits and contractual adjustments, and determine the final payment amount owed to the provider.
Question 3: What document does an insurer send to a provider explaining how a claim was processed and the payment calculation?
- Advance Beneficiary Notice (ABN)
- Explanation of Benefits (EOB)
- Remittance Advice (RA) (Correct answer)
- Certificate of Coverage
Correct answer: Remittance Advice (RA)
A Remittance Advice (RA) is sent by the payer to the provider detailing how each service on a claim was adjudicated, including allowed amounts, contractual adjustments, and the net payment issued.
Question 4: What is 'accounts receivable' in the context of the healthcare revenue cycle?
- Money owed by the provider to vendors
- Outstanding balances owed to the provider for services rendered (Correct answer)
- The total charges captured before payer adjustments
- Insurance premiums collected at registration
Correct answer: Outstanding balances owed to the provider for services rendered
Accounts receivable (AR) represents the money owed to a healthcare provider for services already delivered but not yet paid by insurers or patients, and managing AR efficiently is critical to a healthy revenue cycle.
Question 5: Which metric measures the average number of days it takes a healthcare organization to collect payment after a service is provided?
- Denial rate
- Days in accounts receivable (Days in AR) (Correct answer)
- Net collection rate
- Point-of-service collection rate
Correct answer: Days in accounts receivable (Days in AR)
Days in accounts receivable (Days in AR) measures how long, on average, it takes to collect payments after services are rendered; a lower number indicates a more efficient revenue cycle.
Question 6: What is a 'write-off' in healthcare revenue cycle management?
- A charge added to a patient's account for late payment
- An amount billed but contractually disallowed by the payer (Correct answer)
- A balance transferred to a collection agency
- A payment posted in error that must be reversed
Correct answer: An amount billed but contractually disallowed by the payer
A write-off is the portion of a billed charge that a provider agrees to forgo, typically because of contractual agreements with payers (contractual adjustment) or because the balance is deemed uncollectible, reducing the outstanding AR balance.
CHAA - Certified Healthcare Access Associate Revenue Cycle Management 7
What is the term for the process of verifying that a patient's insurance policy is active and covers the services to be rendered?