CRCR CRCR - Certified Revenue Cycle Representative Program Revenue Cycle Management Fundamentals Questions and Answers 2 — Questions and Answers
Question 1: Which federal program provides health coverage to individuals aged 65 and older or those with qualifying disabilities?
- Medicaid
- CHIP
- Medicare (Correct answer)
- TRICARE
Correct answer: Medicare
Medicare is the federal health insurance program primarily for individuals 65 and older and for certain younger individuals with disabilities or end-stage renal disease.
Question 2: What does the acronym EOB stand for in healthcare billing?
- Explanation of Benefits (Correct answer)
- Evidence of Billing
- Estimate of Balance
- End of Billing
Correct answer: Explanation of Benefits
An Explanation of Benefits (EOB) is a statement sent to the patient or insured summarizing how a claim was processed by their insurance plan.
Question 3: A healthcare organization's net collection rate drops from 97% to 91%. What is the most likely root cause?
- Increase in patient volume
- Rise in uncollected contractual adjustments or denial write-offs (Correct answer)
- Higher gross charges
- Expansion of service lines
Correct answer: Rise in uncollected contractual adjustments or denial write-offs
A declining net collection rate typically signals that a greater proportion of net-collectible revenue is being written off, often due to increased denials or collections failures.
Question 4: What is the function of a charge master (CDM) in the revenue cycle?
- It tracks outstanding patient balances
- It is a comprehensive list of all billable services, supplies, and their standard charges (Correct answer)
- It stores payer contract terms
- It manages employee payroll for revenue cycle staff
Correct answer: It is a comprehensive list of all billable services, supplies, and their standard charges
The charge master (CDM) is the organization's master list of every service, procedure, and supply with associated charges and billing codes used to generate claims.
Question 5: Which of the following is a front-end revenue cycle function?
- Payment posting
- Denial management
- Patient pre-registration (Correct answer)
- Secondary billing
Correct answer: Patient pre-registration
Patient pre-registration is a front-end function that occurs before or at the time of service, collecting demographic and insurance information to support accurate billing.
Question 6: What is the significance of a payer's timely filing deadline in revenue cycle management?
- It sets the maximum allowed charge for a service
- It defines the window within which a claim must be submitted to be considered for payment (Correct answer)
- It determines the patient's copay amount
- It establishes when a secondary claim should be filed
Correct answer: It defines the window within which a claim must be submitted to be considered for payment
Timely filing deadlines are contractual limits imposed by payers that require claims to be submitted within a specified period after the date of service or claims will be denied.
CRCR CRCR - Certified Revenue Cycle Representative Program Revenue Cycle Management Fundamentals Questions and Answers 2
Which federal program provides health coverage to individuals aged 65 and older or those with qualifying disabilities?