HAC Revenue Cycle Management 3

Question 1

A hospital has a gross charge of $10,000, a contractual adjustment of $4,000, and collected $5,500. What is the net collection rate?

Accepted Answer

91.7%

Answer

Net collection rate = Collections / (Gross Charges − Contractual Adjustments) = $5,500 / $6,000 = 91.7%.

Question 2

What is 'prior authorization' in the context of revenue cycle management?

Accepted Answer

Approval obtained from the payer before delivering certain services

Answer

Prior authorization is payer approval secured before rendering specific services to confirm coverage and medical necessity.

Question 3

Which billing form is primarily used by hospitals and facility-based providers to submit claims to Medicare and Medicaid?

Accepted Answer

UB-04 (CMS-1450)

Answer

The UB-04 (CMS-1450) is the standard institutional claim form used by hospitals, skilled nursing facilities, and other facility providers.

Question 4

What does 'timely filing' refer to in revenue cycle management?

Accepted Answer

Submitting claims to payers within the contractually or legally required time frame

Answer

Timely filing deadlines are set by payers; claims submitted after the deadline are typically denied with no right to appeal.

Question 5

In value-based reimbursement models, providers are primarily rewarded for:

Accepted Answer

Achieving quality outcomes and cost efficiency

Answer

Value-based care reimbursement ties payment to quality metrics, patient outcomes, and cost containment rather than service volume.

(HAC) Healthcare Accounting Certification Practice Test