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
What is the primary purpose of a clearinghouse in the revenue cycle?
Answer: To translate and validate claims before forwarding them to payers
A clearinghouse serves as an intermediary that checks claims for errors and reformats them to meet each payer's specific requirements.
Which denial reason code category under CARC indicates that the service was not covered under the patient's benefit plan?
Answer: OA (Other Adjustment)
OA (Other Adjustment) codes are used when the adjustment does not fit contractual obligation or patient responsibility categories, including non-covered benefits.
A provider's net collection rate is 94%. What does the remaining 6% most likely represent?
Answer: Adjustments, write-offs, and uncollectable amounts
The net collection rate measures the percentage of collectible revenue actually collected; the remainder consists of bad debt, contractual adjustments, and write-offs.
Which document initiated by the payer informs the provider of how a claim was adjudicated and any payment made?
Answer: Remittance advice (ERA/EOB)
The remittance advice (electronic ERA or paper EOB) details claim adjudication decisions, payment amounts, and adjustment reason codes.
In the context of revenue cycle management, what is 'charge capture'?
Answer: Recording all billable services rendered during a patient encounter
Charge capture is the process of recording every billable service, procedure, and supply provided so it can be translated into billable codes.
A payer requests additional clinical documentation to support a submitted claim. This request is called a(n):
Answer: Additional development request (ADR)
An ADR (Additional Development Request) is sent by a payer, often Medicare, when more documentation is needed to process or audit a claim.
Which of the following would most likely cause a claim to be denied for 'timely filing'?
Answer: Submitting a claim after the payer's contractual deadline has passed
Timely filing denials occur when a claim is submitted after the payer's contractual or regulatory deadline, which varies by payer.