Revenue Cycle Management Flashcards
7 cards from real CMRT practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Revenue Cycle Management flashcards as text
Which step in the revenue cycle involves verifying a patient's insurance eligibility BEFORE services are rendered?
Answer: Pre-registration/eligibility verification
Pre-registration and eligibility verification confirm coverage details before the patient receives care, reducing claim denials.
A claim is returned to the provider marked 'unprocessable.' What is the most likely reason?
Answer: The claim is missing required data elements
Unprocessable claims are rejected because they lack required data fields such as NPI, date of service, or patient identifier.
What does the term 'clean claim' mean in revenue cycle management?
Answer: A claim submitted without any coding errors or missing information
A clean claim contains all required information, has no errors, and can be adjudicated by the payer without additional information requests.
Which metric measures the percentage of claims paid on the first submission without denial or rejection?
Answer: First-pass resolution rate (FPRR)
The first-pass resolution rate (FPRR) indicates how often claims are paid without requiring rework or resubmission.
A patient's explanation of benefits (EOB) shows a contractual adjustment. What does this represent?
Answer: The difference between billed charges and the payer-contracted rate
Contractual adjustments reflect the write-off between the provider's billed amount and the negotiated rate with the payer.
Which of the following best describes 'accounts receivable (A/R) aging'?
Answer: A report categorizing outstanding balances by the length of time they have been unpaid
A/R aging reports group unpaid claims into time buckets (0–30, 31–60, 61–90, 90+ days) to prioritize collection follow-up.
Under HIPAA, which transaction standard is used for electronic claims submission from providers to payers?
Answer: X12 837
The HIPAA X12 837 transaction set is the standard electronic format for submitting professional (837P) and institutional (837I) claims.