CMSM Healthcare Finance and Revenue Cycle Management Flashcards

Which US law requires healthcare organizations to provide financial assistance policies and limits on charges for uninsured patients to maintain nonprofit hospital tax-exempt status?

Answer: ACA Section 501(r)

ACA Section 501(r) requires nonprofit hospitals to establish charity care and financial assistance programs as a condition of maintaining their tax-exempt status.

What is the significance of a 'clean claim' in the billing process?

Answer: A claim submitted without errors that can be processed without additional information

A clean claim contains all required data elements without deficiencies, allowing the payer to process and adjudicate it without requesting additional information.

Under Medicare's Prospective Payment System (PPS) for inpatient care, payments are determined primarily by which classification system?

Answer: Diagnosis-Related Groups (DRGs)

Medicare's inpatient PPS uses Diagnosis-Related Groups (DRGs) to classify hospital stays into payment categories based on diagnosis, procedures, and patient characteristics.

A CMSM is tasked with improving cash flow. Which strategy directly accelerates payment collection?

Answer: Implementing automated eligibility checks and electronic remittance posting

Automated eligibility verification reduces front-end errors and electronic remittance posting speeds reconciliation, directly shortening the revenue cycle and improving cash flow.

What is the Stark Law primarily designed to prevent in US healthcare settings?

Answer: Physician self-referral to entities in which they have a financial relationship

The Stark Law (Physician Self-Referral Law) prohibits physicians from referring Medicare/Medicaid patients to entities with which the physician or an immediate family member has a financial relationship.

Which report helps a CMSM identify overdue balances by grouping unpaid claims according to how long they have been outstanding?

Answer: Accounts receivable aging report

An A/R aging report categorizes outstanding balances into time buckets (e.g., 0–30, 31–60, 61–90 days) to prioritize collection efforts on the oldest and largest unpaid accounts.