CMSM CMSM Healthcare Finance and Revenue Cycle Management 2

Question 1

A CMSM is reviewing the facility's payer mix. Which payer type generally reimburses providers at the highest rate?

Accepted Answer

Commercial insurance

Answer

Commercial (private) insurance typically reimburses providers at higher rates than government payers such as Medicare or Medicaid.

Question 2

What is the primary purpose of a charge description master (CDM) in a healthcare facility?

Accepted Answer

To standardize and maintain billable service codes and prices

Answer

The CDM (also called the chargemaster) is a comprehensive list of all billable items, including service codes, descriptions, and standard charges used for billing.

Question 3

Under the No Surprises Act (effective 2022), what must providers do before delivering non-emergency care to self-pay or uninsured patients?

Accepted Answer

Provide a Good Faith Estimate of expected charges

Answer

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.

Question 4

Which financial metric represents the percentage of billed charges actually collected by a healthcare facility?

Accepted Answer

Net collection rate

Answer

The net collection rate measures actual collections against the net amount expected after contractual adjustments, reflecting true revenue cycle efficiency.

Question 5

A medical services manager wants to reduce claim denials related to medical necessity. Which action is most effective?

Accepted Answer

Implement prospective utilization review before services are rendered

Answer

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.

CMSM - Certified Medical Services Manager Practice Test

CMSM - Certified Medical Services Manager Practice Test

CMSM CMSM Healthcare Finance and Revenue Cycle Management 2