CMM Revenue Cycle Management & Medical Billing 2

Question 1

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

Accepted Answer

Point-of-service (POS) cash collection rate

Answer

Net collection rate

Answer

Gross collection rate

Answer

First-pass resolution rate

Question 2

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

Accepted Answer

Failed to collect 12% of contractually allowable revenue

Answer

Collected 88% of its total charges before adjustments

Answer

Wrote off 12% of its charges as bad debt

Answer

Collected 88% of claims on the first submission

Question 3

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

Accepted Answer

ICD-10-CM

Answer

CPT-4

Answer

HCPCS Level II

Answer

SNOMED-CT

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:

Accepted Answer

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

Answer

Immediately outsource billing to a third-party vendor

Answer

Hire additional billing staff to resubmit denied claims faster

Answer

Write off all denied claims to avoid further administrative cost

Question 5

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

Accepted Answer

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

Answer

Physicians may always self-refer if they disclose the relationship to the patient

Answer

The law applies only to referrals for surgical procedures

Answer

Violations result only in civil monetary penalties with no exclusion from federal programs

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?

Accepted Answer

Modifier -GC

Answer

Modifier -25

Answer

Modifier -51

Answer

Modifier -59

Question 7

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

Accepted Answer

To ensure all services rendered are accurately documented and billed

Answer

To verify that all payer contracts are current

Answer

To reconcile the practice's bank statements with payer remittances

Answer

To evaluate the cost-effectiveness of clinical supplies