CMSM CMSM Healthcare Finance and Revenue Cycle Management

Question 1

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

Accepted Answer

Eligibility verification

Answer

Pre-authorization

Answer

Claims adjudication

Answer

Remittance posting

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?

Accepted Answer

Charge capture

Answer

Remittance posting

Answer

Collections

Answer

Patient scheduling

Question 3

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

Accepted Answer

Medicare

Answer

Medicaid

Answer

TRICARE

Answer

CHIP

Question 4

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

Accepted Answer

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

Answer

The number of days to process a patient discharge

Answer

The total outstanding balance owed by the facility

Answer

The number of denied claims per month

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?

Accepted Answer

Explanation of Benefits (EOB)

Answer

Superbill

Answer

Encounter form

Answer

Advance Beneficiary Notice (ABN)

Question 6

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

Accepted Answer

CPT (Current Procedural Terminology)

Answer

ICD-10-CM

Answer

SNOMED CT

Answer

NDC codes