CMRT Revenue Cycle Management 2

Question 1

Which step in the revenue cycle involves verifying a patient's insurance eligibility BEFORE services are rendered?

Accepted Answer

Pre-registration/eligibility verification

Answer

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?

Accepted Answer

The claim is missing required data elements

Answer

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?

Accepted Answer

A claim submitted without any coding errors or missing information

Answer

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?

Accepted Answer

First-pass resolution rate (FPRR)

Answer

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?

Accepted Answer

The difference between billed charges and the payer-contracted rate

Answer

Contractual adjustments reflect the write-off between the provider's billed amount and the negotiated rate with the payer.

(CMRT) Certified Medical Records Technician Practice Test