EHR Revenue Cycle & Billing Integration 3 — Questions and Answers
Question 1: What is the purpose of the National Provider Identifier (NPI) in billing?
- It identifies the patient's primary insurance plan
- It is a unique 10-digit identifier assigned to healthcare providers for use in standard transactions (Correct answer)
- It represents the procedure code billed on a claim
- It is a code used to identify the diagnosis on a claim
Correct answer: It is a unique 10-digit identifier assigned to healthcare providers for use in standard transactions
HIPAA requires all covered healthcare providers to obtain an NPI, which uniquely identifies them in administrative and financial transactions.
Question 2: Which revenue cycle metric measures the average number of days it takes to collect payment after a service is rendered?
- Clean claim rate
- Days in Accounts Receivable (AR) (Correct answer)
- Denial rate
- Net collection rate
Correct answer: Days in Accounts Receivable (AR)
Days in AR is a key performance indicator measuring the average time from service to payment receipt; a lower number indicates more efficient collections.
Question 3: A patient has both Medicare and an employer-sponsored plan. Which payer typically pays first?
- Medicare always pays first regardless of other coverage
- The employer-sponsored plan pays first if the employer has 20 or more employees (Correct answer)
- Medicaid pays first, then Medicare
- The payer with the higher reimbursement rate pays first
Correct answer: The employer-sponsored plan pays first if the employer has 20 or more employees
Medicare Secondary Payer (MSP) rules require employer group health plans with 20+ employees to pay primary when an active employee or their spouse is covered.
Question 4: What does 'balance billing' refer to in healthcare billing?
- Billing the patient for the difference between the provider's charge and what the insurer paid (Correct answer)
- The process of reconciling daily cash receipts
- Sending multiple invoices for the same service
- Adjusting charges based on a patient's income
Correct answer: Billing the patient for the difference between the provider's charge and what the insurer paid
Balance billing occurs when a provider bills the patient for the amount remaining after insurance payment, which is prohibited in many circumstances (e.g., for Medicare or in-network patients).
Question 5: In ICD-10-PCS coding, which of the following describes the correct structure of a procedure code?
- 3-digit numeric code
- 5-character alphanumeric code
- 7-character alphanumeric code (Correct answer)
- 10-digit numeric code
Correct answer: 7-character alphanumeric code
ICD-10-PCS codes always consist of exactly 7 characters, each representing a specific axis of classification such as section, body system, and operation.
Question 6: What is a 'write-off' in the revenue cycle?
- The amount collected from the patient at time of service
- An adjustment that removes a balance from accounts receivable that will not be collected (Correct answer)
- The total charges submitted to an insurance company
- A fee charged by the clearinghouse per claim submission
Correct answer: An adjustment that removes a balance from accounts receivable that will not be collected
Write-offs reduce the AR balance by removing amounts contractually adjusted (contractual write-offs) or deemed uncollectable (bad debt write-offs).
Question 7: Which modifier is commonly appended to a CPT code to indicate that a procedure was performed on the left side of the body?
- Modifier 51
- Modifier LT (Correct answer)
- Modifier 59
- Modifier 25
Correct answer: Modifier LT
HCPCS Modifier LT (Left Side) is used to identify procedures performed on the left side of the body to distinguish laterality.
EHR Revenue Cycle & Billing Integration 3
What is the purpose of the National Provider Identifier (NPI) in billing?