Revenue Cycle Management 3 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 3 flashcards as text
Which term describes the process of verifying that a payer will reimburse for a specific service before it is rendered?
Answer: Prior authorization
Prior authorization (also called pre-authorization or pre-certification) is the process of obtaining payer approval before delivering a service to confirm coverage and reimbursement, reducing the risk of claim denial.
What is the term for the time limit a provider has to submit a claim to a payer after a service is rendered?
Answer: Timely filing deadline
Timely filing deadline refers to the contractually or legally defined window within which a provider must submit a claim. Missing this deadline is a common reason for claim denial that typically cannot be appealed.
In the revenue cycle, what does 'accounts receivable' (A/R) represent?
Answer: Outstanding balances owed to the provider for services rendered
Accounts receivable represents money owed to the healthcare organization for services already provided but not yet paid. Monitoring A/R days is a key indicator of revenue cycle efficiency.
Which step in the revenue cycle involves reviewing an Explanation of Benefits (EOB) and posting payments to patient accounts?
Answer: Payment posting
Payment posting is the process of recording payments received from payers and patients into the billing system, using the EOB or Electronic Remittance Advice (ERA) to match payments to claims.
What is the purpose of a 'write-off' in healthcare revenue cycle management?
Answer: To adjust or remove a balance the provider has agreed not to collect
A write-off is an accounting adjustment that removes a balance from accounts receivable that the provider cannot or has contractually agreed not to collect, such as contractual adjustments with insurers or uncollectable bad debt.
Which metric measures the average number of days it takes a healthcare organization to collect payment after a service is provided?
Answer: Days in accounts receivable (A/R days)
Days in accounts receivable (A/R days) measures the average time between service delivery and payment collection. A lower number indicates a more efficient billing and collections process.