CMRT Revenue Cycle Management 2 — Questions and Answers
Question 1: Which step in the revenue cycle involves verifying a patient's insurance eligibility BEFORE services are rendered?
- Claims submission
- Pre-authorization
- Pre-registration/eligibility verification (Correct answer)
- Remittance posting
Correct answer: Pre-registration/eligibility verification
Pre-registration and eligibility verification confirm coverage details before the patient receives care, reducing claim denials.
Question 2: A claim is returned to the provider marked 'unprocessable.' What is the most likely reason?
- The diagnosis code is not medically necessary
- The claim is missing required data elements (Correct answer)
- The payer has already adjudicated the claim
- The patient has a secondary insurance
Correct 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.
Question 3: What does the term 'clean claim' mean in revenue cycle management?
- A claim with no outstanding patient balance
- A claim submitted without any coding errors or missing information (Correct answer)
- A claim that has been paid in full by the payer
- A claim that passed internal audit review
Correct 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.
Question 4: Which metric measures the percentage of claims paid on the first submission without denial or rejection?
- Days in accounts receivable
- First-pass resolution rate (FPRR) (Correct answer)
- Net collection rate
- Denial rate
Correct answer: First-pass resolution rate (FPRR)
The first-pass resolution rate (FPRR) indicates how often claims are paid without requiring rework or resubmission.
Question 5: A patient's explanation of benefits (EOB) shows a contractual adjustment. What does this represent?
- An amount the patient owes after the deductible
- The difference between billed charges and the payer-contracted rate (Correct answer)
- A penalty applied for late claim submission
- An administrative fee charged by the clearinghouse
Correct 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.
Question 6: Which of the following best describes 'accounts receivable (A/R) aging'?
- The process of appealing denied claims by age of service
- A report categorizing outstanding balances by the length of time they have been unpaid (Correct answer)
- The annual depreciation of medical billing software
- A method for calculating patient financial hardship
Correct 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.
Question 7: Under HIPAA, which transaction standard is used for electronic claims submission from providers to payers?
- X12 837 (Correct answer)
- X12 835
- X12 270/271
- X12 276/277
Correct answer: X12 837
The HIPAA X12 837 transaction set is the standard electronic format for submitting professional (837P) and institutional (837I) claims.
CMRT Revenue Cycle Management 2
Which step in the revenue cycle involves verifying a patient's insurance eligibility BEFORE services are rendered?