CMSM CMSM Healthcare Finance and Revenue Cycle Management 1

Question 1

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

Accepted Answer

Eligibility verification

Answer

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?

Accepted Answer

Charge capture

Answer

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?

Accepted Answer

Medicare

Answer

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?

Accepted Answer

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

Answer

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?

Accepted Answer

Explanation of Benefits (EOB)

Answer

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.

CMSM - Certified Medical Services Manager Practice Test