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

Eligibility verification confirms a patient's insurance coverage and benefits before the visit, reducing claim denials.

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

A DAR of 52 days exceeds the industry benchmark of 45 days, signaling the practice's collections are slower than optimal.

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 clean claim includes all required data elements and is free of errors, enabling the payer to process it without requesting additional information.

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

Physician work RVU, which reflects the time, skill, and effort of the provider, typically constitutes the largest portion of the total RVU.

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

CO-4 (Claim Adjustment Reason Code 4) means the service or procedure code is inconsistent with the modifier, requiring correction before resubmission.

(CMM) Certified Medical Manager Practice Test

(CMM) Certified Medical Manager Practice Test

CMM Revenue Cycle Management & Medical Billing