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

The revenue cycle encompasses every step of earning and collecting revenue: patient access (scheduling, registration, eligibility), clinical documentation, charge capture, coding, claim submission, payment posting, denial management, and patient balance collections.

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 (Clinical Modification) classifies diagnoses, symptoms, and reasons for encounter. ICD-10-PCS (Procedure Coding System) classifies inpatient procedures. Together, they are assigned by coders to drive DRG assignment and hospital inpatient payment.

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

CPT codes (Level I HCPCS) are maintained by the AMA and describe medical, surgical, and diagnostic services. They are used on professional fee claims (CMS-1500 / 837P) and drive reimbursement for physician and outpatient services.

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

MS-DRGs (Medicare Severity Diagnosis Related Groups) classify inpatient stays by diagnoses, procedures, age, sex, and complications/comorbidities into groups with assigned payment weights. Medicare pays a fixed amount per DRG — incentivizing efficiency.

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

Charge capture ensures every service performed (procedures, medications, supplies, professional fees) generates a corresponding charge in the EHR/billing system. Missed charges = lost revenue; duplicate charges = overbilling compliance risk.

Epic Skills Assessment Practice Test

Epic Skills Assessment Practice Test

Epic Skills Assessment Revenue Cycle and Billing 1