CMM Revenue Cycle Management & Medical Billing

Question 1

Which step in the revenue cycle occurs BEFORE a patient visit to ensure financial responsibility is established?

Accepted Answer

Eligibility verification

Answer

Claims adjudication

Answer

Accounts receivable follow-up

Answer

Remittance posting

Question 2

A medical practice has a Days in Accounts Receivable (DAR) of 52 days. According to best practices, this figure indicates:

Accepted Answer

Performance slightly above the 45-day benchmark

Answer

Excellent billing efficiency

Answer

A problem requiring immediate intervention

Answer

An acceptable rate for specialty practices only

Question 3

What is a 'clean claim' in medical billing?

Accepted Answer

A claim that contains all required information for prompt payer processing

Answer

A claim with no patient balance due

Answer

A claim submitted without any attachments

Answer

A claim that has been paid in full by the insurance carrier

Question 4

Under the Medicare Physician Fee Schedule, which component accounts for the largest portion of the relative value unit (RVU)?

Accepted Answer

Physician work RVU

Answer

Malpractice expense RVU

Answer

Practice expense RVU

Answer

Geographic practice cost index (GPCI)

Question 5

A claim is denied with remark code CO-4. This code indicates:

Accepted Answer

The procedure code is inconsistent with the modifier

Answer

The service was not medically necessary

Answer

The claim was submitted past the timely filing deadline

Answer

The patient is not eligible on the date of service

Question 6

Which federal law requires that physician practices implement specific safeguards to protect electronically transmitted health information during billing processes?

Accepted Answer

HIPAA Security Rule

Answer

Stark Law

Answer

False Claims Act

Answer

Anti-Kickback Statute

Question 7

In medical billing, what does the term 'contractual adjustment' represent?

Accepted Answer

The difference between the billed charge and the payer's allowed amount

Answer

The amount the patient owes after insurance pays

Answer

A penalty applied for late claim submission

Answer

The write-off applied when a patient cannot pay