CMM Revenue Cycle Management & Medical Billing 3

Question 1

A practice manager is evaluating whether to appeal a denied claim. Which factor is MOST important to assess first?

Accepted Answer

Whether the appeal deadline specified in the payer contract has passed

Answer

The age and tenure of the billing specialist who submitted the claim

Answer

The total number of claims submitted to that payer in the current month

Answer

The patient's credit score and likelihood of self-pay collections

Question 2

Which of the following is an example of upcoding, a fraudulent billing practice?

Accepted Answer

Billing for a 99213 when documentation only supports a 99212

Answer

Billing a 99213 office visit when documentation supports a 99214

Answer

Appending modifier -25 to a significant, separately identifiable E&M service on the same day as a procedure

Answer

Using an unlisted procedure code when no specific CPT code applies

Question 3

A medical practice wants to improve patient collections. Which strategy has been shown to be MOST effective?

Accepted Answer

Collecting patient responsibility amounts at the time of service

Answer

Sending patients to collections after 30 days of non-payment

Answer

Eliminating patient statements to reduce administrative costs

Answer

Requiring payment in full before scheduling appointments for all services

Question 4

In value-based payment models, which metric directly measures whether a practice's spending on a patient population aligns with the payer's budget target?

Accepted Answer

Per Member Per Month (PMPM) cost

Answer

Patient satisfaction score

Answer

Relative Value Unit (RVU) productivity

Answer

First-pass claim acceptance rate

Question 5

Which federal program requires providers to submit cost reports annually, and uses those reports to reconcile interim payments made throughout the year?

Accepted Answer

Medicare Fee-for-Service (Traditional Medicare)

Answer

Medicare Advantage Part C

Answer

Medicaid Managed Care

Answer

Children's Health Insurance Program (CHIP)

Question 6

A practice's accounts receivable aging report shows that 35% of outstanding balances are over 120 days. This level is BEST described as:

Accepted Answer

A significant red flag indicating collection process problems

Answer

Acceptable for large multi-specialty practices

Answer

A positive indicator of payer mix diversity

Answer

Normal variation due to Medicare's slow payment cycle

Question 7

Which of the following best describes the purpose of a remittance advice (RA) in the billing cycle?

Accepted Answer

A payer's explanation of how a claim was adjudicated and what was paid or denied

Answer

A document sent to patients explaining their out-of-pocket costs

Answer

A report generated by the practice's EHR to track outstanding claims

Answer

A notice from the state licensing board regarding billing compliance