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 recovery audit program is specifically authorized to identify Medicare overpayments and underpayments?
Answer: Recovery Audit Contractor (RAC)
RAC auditors are authorized by CMS to identify improper Medicare payments—both overpayments and underpayments—on a contingency-fee basis.
A provider receives a demand letter from Medicare requesting repayment of an alleged overpayment. What is the first formal step to dispute this finding?
Answer: Submit a redetermination request to the MAC within 120 days
The first level of the Medicare appeals process is a redetermination request submitted to the MAC, which must be filed within 120 days of the initial determination.
What does 'coordination of benefits (COB)' refer to in medical billing?
Answer: Determining the correct order and limits of payment when a patient has more than one health plan
COB rules establish the order in which payers are responsible for payment and prevent total reimbursement from exceeding 100% of the covered expense.
Under the False Claims Act, what is the minimum civil penalty per false claim submitted to the federal government?
Answer: $13,000 (adjusted for inflation)
The False Claims Act imposes civil penalties of approximately $13,000–$26,000 per false claim (amounts adjusted periodically for inflation), plus three times the actual damages.
Which modifier is appended to a CPT code to indicate that a procedure was performed bilaterally during the same operative session?
Answer: -50
Modifier -50 is used to indicate that the identical procedure was performed on both sides of the body during the same operative session.
A facility's days in accounts receivable (DAR) is 52. Which situation would most likely cause this number to increase?
Answer: A rise in claim denial rates requiring rework before resubmission
Higher denial rates mean claims must be corrected and resubmitted, delaying payment and increasing the average number of days receivables remain outstanding.
Which of the following describes the role of a 'charge master' (CDM) in hospital revenue cycle management?
Answer: A comprehensive list of all services, procedures, and supplies with their associated prices and billing codes
The charge description master (CDM) is the facility's master price list that links each service or supply to its billing code (CPT/HCPCS) and internal charge amount.