CMRT Revenue Cycle Management 3

Question 1

What is the primary purpose of a clearinghouse in the revenue cycle?

Accepted Answer

To translate and validate claims before forwarding them to payers

Answer

A clearinghouse serves as an intermediary that checks claims for errors and reformats them to meet each payer's specific requirements.

Question 2

Which denial reason code category under CARC indicates that the service was not covered under the patient's benefit plan?

Accepted Answer

OA (Other Adjustment)

Answer

OA (Other Adjustment) codes are used when the adjustment does not fit contractual obligation or patient responsibility categories, including non-covered benefits.

Question 3

A provider's net collection rate is 94%. What does the remaining 6% most likely represent?

Accepted Answer

Adjustments, write-offs, and uncollectable amounts

Answer

The net collection rate measures the percentage of collectible revenue actually collected; the remainder consists of bad debt, contractual adjustments, and write-offs.

Question 4

Which document initiated by the payer informs the provider of how a claim was adjudicated and any payment made?

Accepted Answer

Remittance advice (ERA/EOB)

Answer

The remittance advice (electronic ERA or paper EOB) details claim adjudication decisions, payment amounts, and adjustment reason codes.

Question 5

In the context of revenue cycle management, what is 'charge capture'?

Accepted Answer

Recording all billable services rendered during a patient encounter

Answer

Charge capture is the process of recording every billable service, procedure, and supply provided so it can be translated into billable codes.

(CMRT) Certified Medical Records Technician Practice Test

(CMRT) Certified Medical Records Technician Practice Test

CMRT Revenue Cycle Management 3