Revenue Cycle Management & Medical Billing Flashcards

Which metric best measures a practice's success in collecting payments from patients at or near the point of service?

Answer: Point-of-service (POS) cash collection rate

The point-of-service cash collection rate specifically measures the percentage of patient responsibility amounts collected at the time of the visit.

A practice's net collection rate is 88%. This means the practice:

Answer: Failed to collect 12% of contractually allowable revenue

The net collection rate measures collections against net revenue (charges minus contractual adjustments), so 88% means 12% of allowable revenue was not collected.

Which coding system is required for reporting diagnoses in all HIPAA-covered transactions in the United States?

Answer: ICD-10-CM

ICD-10-CM (International Classification of Diseases, 10th Revision, Clinical Modification) is mandated for diagnosis coding in all HIPAA-covered electronic transactions.

A medical manager notices that the practice's denial rate has risen to 15%. The first step in addressing this problem should be:

Answer: Analyze denial patterns by payer, code, and reason to identify root causes

Root cause analysis by denial category is the foundational step that reveals whether denials stem from coding, eligibility, authorization, or other systemic issues.

Under the Stark Law (Physician Self-Referral Law), which of the following is TRUE?

Answer: Physicians are prohibited from referring Medicare/Medicaid patients to entities with which they have a financial relationship, absent an exception

The Stark Law prohibits physician self-referral for designated health services covered by Medicare/Medicaid unless a specific statutory or regulatory exception applies.

Which of the following billing modifiers indicates that a procedure was performed by a resident under the supervision of a teaching physician who was present for the key portions?

Answer: Modifier -GC

Modifier -GC is used when a resident performs a service under the teaching physician exception rules, indicating the teaching physician was present for key portions.

What is the primary purpose of a charge capture audit in a medical practice?

Answer: To ensure all services rendered are accurately documented and billed

Charge capture audits compare services documented in the medical record against what was billed to identify missed charges, over-billing, or coding inaccuracies.