Technology and Data Analytics Flashcards
7 cards from real CRCR practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Technology and Data Analytics flashcards as text
Which data analytics technique is most appropriate when a revenue cycle team wants to predict which claims are likely to be denied before submission?
Answer: Predictive analytics
Predictive analytics uses historical data and machine learning models to forecast future outcomes such as claim denial probability.
A hospital's EHR system must exchange patient data with a payer's system using a standardized messaging format. Which protocol is most commonly used for this real-time clinical data exchange?
Answer: HL7 FHIR
HL7 FHIR (Fast Healthcare Interoperability Resources) is the current standard for real-time, API-based clinical data exchange between systems.
When analyzing accounts receivable data, a revenue cycle analyst notices a spike in days in A/R for a specific payer. Which dashboard metric would best help isolate the root cause?
Answer: Denial rate by payer and denial reason code
Breaking down denial rate by payer and reason code pinpoints whether increased A/R days stem from a specific denial pattern tied to that payer.
Under the HIPAA Security Rule, which safeguard category requires policies such as workforce training, access management, and sanction policies for employees who misuse PHI?
Answer: Administrative safeguards
Administrative safeguards are the policies and procedures that govern workforce conduct and management of PHI access under the HIPAA Security Rule.
A revenue cycle department implements robotic process automation (RPA) for eligibility verification. Which outcome best represents the primary benefit of this technology?
Answer: Reduction in manual data entry errors and processing time
RPA automates repetitive rule-based tasks like eligibility checks, reducing human error and accelerating the verification process.
Which key performance indicator (KPI) measures the percentage of claims that are accepted and paid on the first submission without requiring rework?
Answer: First-pass resolution rate (FPRR)
The first-pass resolution rate (FPRR) tracks the percentage of claims adjudicated correctly on initial submission, reflecting billing accuracy.
A revenue cycle manager wants to use data to identify patterns in patient no-shows that lead to billing gaps. This use of historical operational data to understand why a problem occurred is called:
Answer: Diagnostic analytics
Diagnostic analytics drills into historical data to identify root causes and explain why specific outcomes occurred.