CPAT Revenue Cycle Management & Denial Management Flashcards
6 cards from real CPAT practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 6 CPAT Revenue Cycle Management & Denial Management flashcards as text
What is 'underpayment' in revenue cycle management?
Answer: When a payer reimburses less than the contracted rate for a service
Underpayment occurs when an insurer pays less than the negotiated contract rate, requiring follow-up to recover the contractual difference.
What does 'charge capture' refer to in revenue cycle management?
Answer: The process of identifying, recording, and submitting all billable services provided to a patient
Charge capture ensures all services rendered are accurately documented and submitted for billing to maximize appropriate reimbursement.
What is a 'payer mix' in healthcare finance?
Answer: The distribution of different payer types (Medicare, Medicaid, commercial, self-pay) in a provider's patient population
Payer mix significantly impacts revenue because different payers reimburse at different rates, with Medicare and Medicaid typically lower than commercial payers.
What is the purpose of a 'secondary claim'?
Answer: To bill the secondary insurance after the primary payer has processed the claim
After the primary payer adjudicates a claim, the remaining patient balance is billed to the secondary payer through a crossover or secondary claim.
What is a 'credit balance' on a patient account?
Answer: An overpayment resulting in more money collected than the amount owed
Credit balances occur when a patient or payer overpays; healthcare providers are legally required to refund credit balances in a timely manner.
Which metric measures the percentage of billed charges actually collected after contractual adjustments?
Answer: Net collection rate
The net collection rate measures how effectively a provider collects what it is entitled to receive after contractual adjustments are applied.