HAC Revenue Cycle Management 2 — Questions and Answers
Question 1: Which metric measures the average number of days a healthcare organization takes to collect payment after a service is rendered?
- Days Sales Outstanding (DSO) (Correct answer)
- Net Collection Rate
- Denial Rate
- Accounts Receivable Turnover
Correct answer: Days Sales Outstanding (DSO)
Days Sales Outstanding (DSO) measures the average number of days between service delivery and payment receipt.
Question 2: A claim is denied because the patient's insurance had lapsed on the date of service. This is classified as what type of denial?
- Clinical denial
- Eligibility denial (Correct answer)
- Duplicate claim denial
- Authorization denial
Correct answer: Eligibility denial
Eligibility denials occur when a patient's coverage is inactive or invalid on the date services were provided.
Question 3: What does the term 'clean claim' mean in revenue cycle management?
- A claim with no outstanding balance
- A claim submitted without errors that can be processed without additional information (Correct answer)
- A claim that has been fully adjudicated
- A claim approved by the compliance department
Correct 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.
Question 4: In healthcare revenue cycle, what is a 'remittance advice' (RA)?
- A patient statement showing balance due
- A document from the payer explaining claim payment or denial decisions (Correct answer)
- A referral form from the primary care physician
- An internal audit report on billing accuracy
Correct 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.
Question 5: Which of the following best describes 'upcoding' in healthcare billing?
- Assigning a higher-level code than the documented service to increase reimbursement (Correct answer)
- Converting ICD-9 codes to ICD-10 codes
- Adding modifier codes to increase specificity
- Billing for services provided at an outpatient rather than inpatient level
Correct 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.
Question 6: What is the purpose of the National Provider Identifier (NPI) in the revenue cycle?
- To identify the patient's insurance group
- To uniquely identify healthcare providers on claims and transactions (Correct answer)
- To classify the type of service rendered
- To assign a unique diagnosis code to each patient
Correct 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.
Question 7: Which process in revenue cycle management involves verifying a patient's insurance benefits and coverage details prior to the date of service?
- Charge capture
- Eligibility verification (Correct answer)
- Utilization review
- Claims adjudication
Correct answer: Eligibility verification
Eligibility verification confirms active coverage, plan benefits, co-pays, and deductibles before services are rendered.
HAC Revenue Cycle Management 2
Which metric measures the average number of days a healthcare organization takes to collect payment after a service is rendered?