CMM Revenue Cycle Management & Medical Billing 2 — Questions and Answers
Question 1: Which metric best measures a practice's success in collecting payments from patients at or near the point of service?
- Net collection rate
- Point-of-service (POS) cash collection rate (Correct answer)
- Gross collection rate
- First-pass resolution rate
Correct 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.
Question 2: A practice's net collection rate is 88%. This means the practice:
- Collected 88% of its total charges before adjustments
- Failed to collect 12% of contractually allowable revenue (Correct answer)
- Wrote off 12% of its charges as bad debt
- Collected 88% of claims on the first submission
Correct 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.
Question 3: Which coding system is required for reporting diagnoses in all HIPAA-covered transactions in the United States?
- CPT-4
- ICD-10-CM (Correct answer)
- HCPCS Level II
- SNOMED-CT
Correct 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.
Question 4: A medical manager notices that the practice's denial rate has risen to 15%. The first step in addressing this problem should be:
- Immediately outsource billing to a third-party vendor
- Analyze denial patterns by payer, code, and reason to identify root causes (Correct answer)
- Hire additional billing staff to resubmit denied claims faster
- Write off all denied claims to avoid further administrative cost
Correct 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.
Question 5: Under the Stark Law (Physician Self-Referral Law), which of the following is TRUE?
- Physicians may always self-refer if they disclose the relationship to the patient
- Physicians are prohibited from referring Medicare/Medicaid patients to entities with which they have a financial relationship, absent an exception (Correct answer)
- The law applies only to referrals for surgical procedures
- Violations result only in civil monetary penalties with no exclusion from federal programs
Correct 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.
Question 6: 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?
- Modifier -25
- Modifier -GC (Correct answer)
- Modifier -51
- Modifier -59
Correct 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.
Question 7: What is the primary purpose of a charge capture audit in a medical practice?
- To verify that all payer contracts are current
- To ensure all services rendered are accurately documented and billed (Correct answer)
- To reconcile the practice's bank statements with payer remittances
- To evaluate the cost-effectiveness of clinical supplies
Correct 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.
CMM Revenue Cycle Management & Medical Billing 2
Which metric best measures a practice's success in collecting payments from patients at or near the point of service?