CMSM Healthcare Finance and Revenue Cycle Management Flashcards
6 cards from real CMSM practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 6 CMSM Healthcare Finance and Revenue Cycle Management flashcards as text
A CMSM is reviewing the facility's payer mix. Which payer type generally reimburses providers at the highest rate?
Answer: Commercial insurance
Commercial (private) insurance typically reimburses providers at higher rates than government payers such as Medicare or Medicaid.
What is the primary purpose of a charge description master (CDM) in a healthcare facility?
Answer: To standardize and maintain billable service codes and prices
The CDM (also called the chargemaster) is a comprehensive list of all billable items, including service codes, descriptions, and standard charges used for billing.
Under the No Surprises Act (effective 2022), what must providers do before delivering non-emergency care to self-pay or uninsured patients?
Answer: Provide a Good Faith Estimate of expected charges
The No Surprises Act requires providers to give self-pay and uninsured patients a Good Faith Estimate of anticipated costs before scheduling or providing non-emergency services.
Which financial metric represents the percentage of billed charges actually collected by a healthcare facility?
Answer: Net collection rate
The net collection rate measures actual collections against the net amount expected after contractual adjustments, reflecting true revenue cycle efficiency.
A medical services manager wants to reduce claim denials related to medical necessity. Which action is most effective?
Answer: Implement prospective utilization review before services are rendered
Prospective utilization review evaluates the medical necessity of services before they are provided, preventing denials that occur when payers determine a service was not medically justified.
Which of the following best describes a capitation payment model?
Answer: A fixed monthly fee paid per enrolled patient regardless of services used
Capitation pays providers a set monthly amount per covered patient, incentivizing preventive care since the provider assumes financial risk for utilization.
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