Revenue Cycle Management 6 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 6 flashcards as text
Which term describes the process of verifying that a patient's insurance policy covers the specific services to be rendered before care is provided?
Answer: Eligibility verification
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.
What is the purpose of an Explanation of Benefits (EOB) in the revenue cycle?
Answer: To detail how an insurance company processed a claim and what it will pay
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.
In revenue cycle management, what does 'days in accounts receivable' (AR days) measure?
Answer: The average number of days it takes to collect payment after a service is rendered
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.
Which action is the most appropriate first step when a claim is denied due to 'lack of medical necessity'?
Answer: Obtain and submit clinical documentation supporting the necessity of the service
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.
What is the role of a chargemaster (charge description master) in the revenue cycle?
Answer: It serves as a comprehensive list of all billable services and their associated charges used by a facility
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.
What is the significance of the 'timely filing' deadline in healthcare billing?
Answer: It is the maximum time a provider has to submit a claim to an insurer after the date of service
Payers impose timely filing limits — often ranging from 90 days to one year — within which a claim must be submitted after the service date; claims filed after this window are typically denied without recourse.