HAC Revenue Cycle Management 2

Question 1

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

Accepted Answer

Days Sales Outstanding (DSO)

Answer

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?

Accepted Answer

Eligibility denial

Answer

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?

Accepted Answer

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

Answer

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)?

Accepted Answer

A document from the payer explaining claim payment or denial decisions

Answer

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?

Accepted Answer

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

Answer

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

(HAC) Healthcare Accounting Certification Practice Test