Epic Skills Assessment Revenue Cycle and Billing 1

Question 1

What is the 'revenue cycle' in healthcare, and what are its main components?

Accepted Answer

The end-to-end financial process from patient scheduling through payment collection, including registration, coding, billing, claims, posting, and denials management

Answer

Only the billing and collections phase of healthcare finance

Answer

The process of budgeting and financial planning for a healthcare organization

Answer

The procurement and supply chain financial cycle

Question 2

What is the difference between ICD-10-CM and ICD-10-PCS codes in medical coding?

Accepted Answer

ICD-10-CM codes diagnoses (why); ICD-10-PCS codes inpatient procedures (what was done) — together they drive DRG assignment and inpatient reimbursement

Answer

ICD-10-CM is for outpatient; ICD-10-PCS is for physician billing

Answer

ICD-10-CM is the current version; ICD-10-PCS is a proposed future standard

Answer

They are used by different payers with no clinical overlap

Question 3

What does CPT (Current Procedural Terminology) code set describe, and who maintains it?

Accepted Answer

Medical procedures and services performed by physicians and other providers; maintained by the American Medical Association (AMA)

Answer

Diagnosis codes for outpatient billing; maintained by WHO

Answer

Pharmacy billing codes; maintained by the FDA

Answer

Inpatient procedure codes; maintained by CMS

Question 4

What is a 'Diagnosis Related Group' (DRG), and how does it determine hospital payment?

Accepted Answer

A classification that groups inpatient cases by diagnosis, procedures, and complications into payment categories; hospitals receive a fixed payment per DRG regardless of actual costs

Answer

A diagnostic category used for clinical documentation only

Answer

A group of related outpatient procedures billed together

Answer

A classification of drugs related to a specific disease group

Question 5

What is 'charge capture,' and why is it important to revenue cycle integrity?

Accepted Answer

The process of documenting all billable services rendered during a patient encounter to ensure complete and accurate claim submission

Answer

The collection of copayments at the point of service

Answer

The capture of all patient complaints during registration

Answer

The recording of all charges denied by insurance

Question 6

What is the 'clean claim rate,' and why does it matter for revenue cycle performance?

Accepted Answer

The percentage of claims submitted that are accepted and paid without rejection or additional information requests; higher rates mean faster payment and lower rework costs

Answer

The percentage of claims that pass internal audit review

Answer

The percentage of claims paid within 30 days of submission

Answer

The percentage of claims without any patient balance after insurance payment

Question 7

What is a 'remittance advice' (ERA/EOB), and how is it used in revenue cycle?

Accepted Answer

A document from the payer detailing which charges were paid, denied, adjusted, or pended — used for payment posting and denial management

Answer

A notice sent to patients detailing their financial responsibility

Answer

A billing statement generated by the hospital for the patient

Answer

An authorization document approving future services

Question 8

What is 'medical necessity' in the context of insurance billing?

Accepted Answer

The clinical justification that a service is reasonable, necessary, and appropriate for the diagnosis and condition, required by payers as a condition of reimbursement

Answer

The minimum number of visits required by a condition protocol

Answer

The physical necessity of a medication for survival

Answer

Documentation that a procedure was performed by a licensed clinician

Question 9

What does 'unbundling' in medical billing refer to, and why is it a compliance risk?

Accepted Answer

Separately billing procedure codes that should be billed as a bundled package code, artificially increasing reimbursement — a compliance violation under CCI edits and OIG guidance

Answer

Separating inpatient from outpatient charges on the same claim

Answer

Billing multiple diagnoses on the same claim form

Answer

Submitting claims to multiple payers for the same service legitimately

Question 10

What is the 'accounts receivable (A/R) days' metric in revenue cycle management?

Accepted Answer

The average number of days from service delivery to payment receipt; lower is better, with industry benchmark typically <50 days for hospitals

Answer

The total dollar amount owed by all patients

Answer

The number of days the billing department has to submit claims

Answer

The average patient copay collection rate per day