CPAT CPAT Revenue Cycle Management & Denial Management 2

Question 1

What is a 'write-off' in revenue cycle management?

Accepted Answer

Adjusting an account balance to zero when it is uncollectible or contractually adjusted

Answer

Write-offs remove uncollectible balances (bad debt) or contractual adjustments (payer discounts) from accounts receivable.

Question 2

What is the purpose of a remittance advice (RA) or explanation of benefits (EOB)?

Accepted Answer

A document from the payer explaining how a claim was adjudicated and what amount was paid

Answer

The RA/EOB details payment amounts, adjustments, patient responsibility, and denial reasons for each claim processed by the payer.

Question 3

What does 'timely filing' mean in medical billing?

Accepted Answer

Submitting claims to the payer within the payer's required deadline

Answer

Timely filing limits set by payers define the window within which claims must be submitted to be eligible for payment.

Question 4

What action should be taken when a claim is denied for 'lack of medical necessity'?

Accepted Answer

Submit additional clinical documentation supporting the medical necessity of the service

Answer

Medical necessity denials require submitting clinical records, physician notes, or a letter of medical necessity to support the appropriateness of care.

Question 5

What is the function of an 'appeal' in revenue cycle management?

Accepted Answer

Formally challenging a payer's denial decision with supporting documentation

Answer

An appeal is a formal request asking the payer to reconsider a denied or underpaid claim, often accompanied by supporting documentation.

CPAT - Certified Patient Account Technician Practice Test

CPAT - Certified Patient Account Technician Practice Test

CPAT CPAT Revenue Cycle Management & Denial Management 2