Revenue Cycle Management 2 Flashcards
6 cards from real CHAA practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 6 Revenue Cycle Management 2 flashcards as text
What is the primary purpose of obtaining prior authorization in the revenue cycle?
Answer: To confirm that a payer will cover a specific service before it is rendered
Prior authorization is a payer requirement that must be obtained before certain services are performed. It confirms coverage eligibility and reduces the risk of claim denial due to medical necessity disputes.
Which metric measures the average number of days it takes a healthcare organization to collect payment after a service is rendered?
Answer: Days in accounts receivable (A/R days)
Days in accounts receivable (A/R days) tracks how long outstanding balances remain unpaid. A lower number indicates a more efficient revenue cycle and faster reimbursement.
What is the function of a remittance advice (RA) in the revenue cycle?
Answer: It explains how a payer processed a claim and what amount was paid or denied
A remittance advice is sent by the payer to the provider after processing a claim. It details payment amounts, adjustments, and denial reasons, allowing the billing team to reconcile accounts.
When a patient has both a primary and a secondary insurance plan, which process determines the order in which plans pay?
Answer: Coordination of benefits (COB)
Coordination of benefits (COB) establishes which plan pays first (primary) and which pays second (secondary), preventing duplicate payment and ensuring the patient is not reimbursed more than 100% of the cost.
A hospital writes off a balance because it is contractually prohibited from billing the patient for the difference between its charge and the payer's allowed amount. This is known as a:
Answer: Contractual adjustment
A contractual adjustment reduces the billed charge to the payer-allowed amount as required by the provider's contract. Unlike bad debt, it is an expected and pre-agreed reduction, not an uncollectible balance.
Which step in the revenue cycle involves verifying that a patient's insurance is active and that the provider is in-network before the date of service?
Answer: Eligibility and benefits verification
Eligibility and benefits verification confirms that the patient's coverage is active, identifies the plan's in-network status, and determines cost-sharing responsibilities such as deductibles and copays before service is delivered.