CMSM CMSM Healthcare Finance and Revenue Cycle Management 1 — Questions and Answers
Question 1: Which step in the revenue cycle involves verifying a patient's insurance coverage before a scheduled appointment?
- Pre-authorization
- Eligibility verification (Correct answer)
- Claims adjudication
- Remittance posting
Correct answer: Eligibility verification
Eligibility verification confirms a patient's active insurance coverage and benefits before the date of service to prevent claim denials.
Question 2: A medical services manager notices a high rate of claim denials due to missing modifier codes. Which revenue cycle phase should be audited first?
- Charge capture (Correct answer)
- Remittance posting
- Collections
- Patient scheduling
Correct answer: Charge capture
Charge capture is the phase where services are coded and billed, so missing modifier codes indicate a deficiency in this step.
Question 3: Which federal program provides healthcare coverage primarily for individuals aged 65 and older in the United States?
- Medicaid
- TRICARE
- Medicare (Correct answer)
- CHIP
Correct answer: Medicare
Medicare is the federal health insurance program designed for Americans aged 65 and older, as well as certain younger individuals with disabilities.
Question 4: What does the term 'accounts receivable (A/R) days' measure in healthcare finance?
- The number of days to process a patient discharge
- The average number of days it takes to collect payment after a service is rendered (Correct answer)
- The total outstanding balance owed by the facility
- The number of denied claims per month
Correct 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.
Question 5: Under the US healthcare system, which document details the payment made by an insurer to a provider, including adjustments and denied line items?
- Superbill
- Explanation of Benefits (EOB) (Correct answer)
- Encounter form
- Advance Beneficiary Notice (ABN)
Correct 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.
Question 6: Which coding system is primarily used for outpatient facility billing of procedures and services in the US?
- ICD-10-CM
- CPT (Current Procedural Terminology) (Correct answer)
- SNOMED CT
- NDC codes
Correct 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.
CMSM CMSM Healthcare Finance and Revenue Cycle Management 1
Which step in the revenue cycle involves verifying a patient's insurance coverage before a scheduled appointment?