CHAA - Certified Healthcare Access Associate Revenue Cycle Management 8 — Questions and Answers
Question 1: Which metric measures the average number of days it takes a healthcare organization to collect payment after a service is provided?
- Accounts payable turnover
- Days in accounts receivable (AR) (Correct answer)
- Net collection rate
- Denial rate
Correct answer: Days in accounts receivable (AR)
Days in accounts receivable (AR) measures the average time from service delivery to payment collection, making it a key performance indicator for revenue cycle efficiency.
Question 2: What is the primary function of a remittance advice (RA) in the revenue cycle?
- To authorize a patient's procedure before treatment
- To explain how a payer processed and adjudicated a submitted claim (Correct answer)
- To document a patient's medical history for billing purposes
- To request additional clinical information from the provider
Correct answer: To explain how a payer processed and adjudicated a submitted claim
A remittance advice (also called an explanation of benefits) details how the payer adjudicated the claim, including amounts paid, adjusted, or denied, allowing the provider to post payments and identify discrepancies.
Question 3: In revenue cycle management, what does 'write-off' refer to?
- Recording a patient payment in the billing system
- Transferring a balance to a secondary insurance payer
- Adjusting an uncollectable balance off the accounts receivable (Correct answer)
- Submitting a corrected claim to the insurance company
Correct answer: Adjusting an uncollectable balance off the accounts receivable
A write-off is the formal removal of an uncollectable amount from accounts receivable, such as amounts exceeding contracted rates or balances deemed uncollectable after collection efforts.
Question 4: Which of the following best describes 'coordination of benefits' (COB) in healthcare billing?
- A process for verifying that a patient's diagnosis matches the billed procedure
- A method for determining the order in which multiple insurers pay on a claim (Correct answer)
- A system used to track patient copayments at the time of service
- An agreement between providers to share revenue from shared patients
Correct answer: A method for determining the order in which multiple insurers pay on a claim
Coordination of benefits establishes which insurer pays first (primary) and which pays second (secondary) when a patient has multiple insurance plans, preventing duplicate payments.
Question 5: What is the purpose of a healthcare organization's chargemaster (CDM)?
- To document patient demographic and insurance information
- To list all services, supplies, and their associated charges billed by the facility (Correct answer)
- To track outstanding balances owed by third-party payers
- To record clinical outcomes associated with specific diagnoses
Correct answer: To list all services, supplies, and their associated charges billed by the facility
The chargemaster (charge description master) is the comprehensive list of every service, procedure, and supply a facility can bill, along with the associated standard charge, forming the foundation of the billing process.
Question 6: Which term describes the process of verifying that the diagnosis codes submitted on a claim support the medical necessity of the billed procedure?
- Charge reconciliation
- Claim scrubbing
- Coding compliance auditing
- Medical necessity review (Correct answer)
Correct answer: Medical necessity review
Medical necessity review evaluates whether the documented diagnosis codes justify the procedure or service billed, ensuring that payers will recognize the clinical appropriateness of the treatment provided.
CHAA - Certified Healthcare Access Associate Revenue Cycle Management 8
Which metric measures the average number of days it takes a healthcare organization to collect payment after a service is provided?