Revenue Cycle Fundamentals Flashcards

What is a 'write-off' in the context of healthcare revenue cycle?

Answer: An amount the provider agrees to forgo as uncollectable or contractually disallowed

A write-off is an amount removed from accounts receivable because it is contractually disallowed or deemed uncollectable.

Which of the following is the PRIMARY responsibility of the Patient Access department at the start of the revenue cycle?

Answer: Collecting and verifying patient demographic and insurance information

Patient Access is responsible for accurately collecting demographics and insurance data at registration, which drives the entire revenue cycle.

An Explanation of Benefits (EOB) is sent by the payer to whom?

Answer: Both the provider and the patient

Payers send an EOB to the patient and a remittance advice (RA) to the provider, both explaining claim adjudication details.

What does 'accounts receivable (A/R) days' measure?

Answer: The average number of days it takes to collect payment after a service is rendered

A/R days is a key performance metric indicating the average time it takes to collect outstanding balances after services are provided.

Under the 'birthday rule,' when a child is covered by both parents' insurance plans, which plan is primary?

Answer: The plan of the parent whose birthday falls earliest in the calendar year

The birthday rule states that the plan of the parent with the earliest birthday in the calendar year (month and day, not year) is primary.

Which HIPAA-standard transaction is used to check a patient's insurance eligibility electronically?

Answer: 270/271

The 270 transaction is an eligibility inquiry and the 271 is the payer's response confirming or denying coverage.

What is the function of a charge master (charge description master or CDM)?

Answer: To store a comprehensive list of services, procedures, and their associated charges

The charge master is a comprehensive database of all billable services a facility provides, including their codes and standard charges.