Revenue Cycle Management Flashcards

Which metric measures the average number of days a healthcare organization takes to collect payment after a service is rendered?

Answer: Days Sales Outstanding (DSO)

Days Sales Outstanding (DSO) measures the average number of days between service delivery and payment receipt.

A claim is denied because the patient's insurance had lapsed on the date of service. This is classified as what type of denial?

Answer: Eligibility denial

Eligibility denials occur when a patient's coverage is inactive or invalid on the date services were provided.

What does the term 'clean claim' mean in revenue cycle management?

Answer: A claim submitted without errors that can be processed without additional information

A clean claim contains all required data elements and no errors, allowing the payer to process it immediately upon receipt.

In healthcare revenue cycle, what is a 'remittance advice' (RA)?

Answer: A document from the payer explaining claim payment or denial decisions

A remittance advice (RA) or Explanation of Benefits (EOB) is sent by payers to providers detailing how claims were adjudicated.

Which of the following best describes 'upcoding' in healthcare billing?

Answer: Assigning a higher-level code than the documented service to increase reimbursement

Upcoding is a fraudulent practice of billing a higher-complexity or higher-cost code than the actual service documented.

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

Answer: To uniquely identify healthcare providers on claims and transactions

The NPI is a 10-digit unique identifier assigned to healthcare providers for use in all HIPAA-covered transactions including claims.

Which process in revenue cycle management involves verifying a patient's insurance benefits and coverage details prior to the date of service?

Answer: Eligibility verification

Eligibility verification confirms active coverage, plan benefits, co-pays, and deductibles before services are rendered.