CHSA CHSA Healthcare Finance & Revenue Cycle 1 — Questions and Answers
Question 1: Which document outlines the itemized charges for services rendered to a patient during a hospital stay?
- Explanation of Benefits (EOB)
- Uniform Bill (UB-04) (Correct answer)
- Remittance Advice (RA)
- Prior Authorization Form
Correct answer: Uniform Bill (UB-04)
The UB-04 is the standardized claim form used by hospitals to bill institutional services to Medicare, Medicaid, and private insurers.
Question 2: What term describes the process of verifying a patient's insurance coverage and benefits before providing non-emergency care?
- Claims adjudication
- Prior authorization
- Pre-certification/eligibility verification (Correct answer)
- Concurrent review
Correct answer: Pre-certification/eligibility verification
Pre-certification and eligibility verification confirm that the patient's plan is active and covers the planned services before care is delivered.
Question 3: Under Medicare's Prospective Payment System (PPS), hospital reimbursement for inpatient stays is primarily based on:
- Actual days the patient stayed
- Diagnosis-Related Groups (DRGs) (Correct answer)
- Total charges submitted on the claim
- Number of procedures performed
Correct answer: Diagnosis-Related Groups (DRGs)
DRGs group patients with similar diagnoses and expected resource use, and Medicare pays a fixed rate per DRG rather than per service.
Question 4: A charge that a healthcare organization writes off because it exceeds the contracted payer rate is called a:
- Bad debt
- Contractual adjustment (Correct answer)
- Charity care write-off
- Capitation payment
Correct answer: Contractual adjustment
A contractual adjustment is the difference between a provider's billed charge and the negotiated rate the payer is obligated to pay.
Question 5: Which revenue cycle metric measures the average number of days it takes to collect payment after a service is billed?
- Case mix index
- Days in accounts receivable (AR) (Correct answer)
- Denial rate
- Cost-to-charge ratio
Correct answer: Days in accounts receivable (AR)
Days in AR measures how efficiently a healthcare organization converts billed services into cash, with lower values indicating faster collections.
Question 6: What is the purpose of a Medicare Cost Report submitted annually by hospitals?
- To request new DRG assignments
- To reconcile actual costs with interim payments received from Medicare (Correct answer)
- To report physician quality metrics
- To apply for Medicare certification renewal
Correct answer: To reconcile actual costs with interim payments received from Medicare
The Medicare Cost Report reconciles the hospital's actual costs of providing care to Medicare beneficiaries against the interim payments already received during the year.
CHSA CHSA Healthcare Finance & Revenue Cycle 1
Which document outlines the itemized charges for services rendered to a patient during a hospital stay?