Revenue Cycle Management 7 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 7 flashcards as text
What is the term for the process of verifying that a patient's insurance policy is active and covers the services to be rendered?
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.
Which term describes the process by which an insurer reviews a submitted claim and determines the payment amount?
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.
What document does an insurer send to a provider explaining how a claim was processed and the payment calculation?
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.
What is 'accounts receivable' in the context of the healthcare revenue cycle?
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.
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 (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.
What is a 'write-off' in healthcare revenue cycle management?
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.