EHR Revenue Cycle & Billing Integration 3

Question 1

What is the purpose of the National Provider Identifier (NPI) in billing?

Accepted Answer

It is a unique 10-digit identifier assigned to healthcare providers for use in standard transactions

Answer

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?

Accepted Answer

Days in Accounts Receivable (AR)

Answer

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?

Accepted Answer

The employer-sponsored plan pays first if the employer has 20 or more employees

Answer

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?

Accepted Answer

Billing the patient for the difference between the provider's charge and what the insurer paid

Answer

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?

Accepted Answer

7-character alphanumeric code

Answer

ICD-10-PCS codes always consist of exactly 7 characters, each representing a specific axis of classification such as section, body system, and operation.

(EHR) Electronic Health Records Program Certification Practice Test

(EHR) Electronic Health Records Program Certification Practice Test

EHR Revenue Cycle & Billing Integration 3