CMSM Healthcare Finance and Revenue Cycle Management Flashcards

Which step in the revenue cycle involves verifying a patient's insurance coverage before a scheduled appointment?

Answer: Eligibility verification

Eligibility verification confirms a patient's active insurance coverage and benefits before the date of service to prevent claim denials.

A medical services manager notices a high rate of claim denials due to missing modifier codes. Which revenue cycle phase should be audited first?

Answer: Charge capture

Charge capture is the phase where services are coded and billed, so missing modifier codes indicate a deficiency in this step.

Which federal program provides healthcare coverage primarily for individuals aged 65 and older in the United States?

Answer: Medicare

Medicare is the federal health insurance program designed for Americans aged 65 and older, as well as certain younger individuals with disabilities.

What does the term 'accounts receivable (A/R) days' measure in healthcare finance?

Answer: The average number of days it takes to collect payment after a service is rendered

A/R days measures the average time between billing and payment collection, and a lower number indicates a more efficient revenue cycle.

Under the US healthcare system, which document details the payment made by an insurer to a provider, including adjustments and denied line items?

Answer: Explanation of Benefits (EOB)

An Explanation of Benefits (EOB) is issued by the insurer to the provider and patient, detailing how a claim was processed and what amount was paid.

Which coding system is primarily used for outpatient facility billing of procedures and services in the US?

Answer: CPT (Current Procedural Terminology)

CPT codes, maintained by the AMA, are the standard coding system used to report medical, surgical, and diagnostic procedures on outpatient claims.