PAR Revenue Cycle Fundamentals 2 — Questions and Answers
Question 1: Which step in the revenue cycle occurs BEFORE a patient receives services?
- Claims submission
- Pre-authorization (Correct answer)
- Remittance posting
- Denial management
Correct answer: Pre-authorization
Pre-authorization (prior authorization) is obtained from the payer before services are rendered to confirm coverage.
Question 2: What does the term 'clean claim' mean in healthcare billing?
- A claim submitted on paper rather than electronically
- A claim that has been paid in full
- A claim that contains all required information and passes edits without errors (Correct answer)
- A claim submitted within 24 hours of service
Correct answer: A claim that contains all required information and passes edits without errors
A clean claim is one that contains all required data elements and passes all payer edits, allowing it to be processed without delay.
Question 3: Which federal program provides health coverage primarily to individuals with disabilities and end-stage renal disease?
- Medicaid
- CHIP
- Medicare (Correct answer)
- TRICARE
Correct answer: Medicare
Medicare covers individuals 65 and older as well as those under 65 with qualifying disabilities or end-stage renal disease.
Question 4: A patient's insurance card shows a $250 deductible, $30 copay, and 80/20 coinsurance. After meeting the deductible, who pays the 20%?
- The provider
- The government
- The patient (Correct answer)
- The secondary insurer automatically
Correct answer: The patient
Coinsurance is the percentage of costs the patient is responsible for after the deductible has been met.
Question 5: What is the purpose of a remittance advice (RA)?
- To schedule patient appointments
- To explain how a claim was processed and what the payer paid (Correct answer)
- To request medical records from providers
- To notify patients of upcoming deductibles
Correct answer: To explain how a claim was processed and what the payer paid
A remittance advice explains the payer's adjudication of a claim, including payments, adjustments, and denial reasons.
Question 6: Which of the following best describes 'coordination of benefits' (COB)?
- A process to verify a patient's identity before registration
- A method to determine which insurer pays first when a patient has multiple coverages (Correct answer)
- A technique for coding diagnoses accurately
- A procedure to appeal denied claims
Correct answer: A method to determine which insurer pays first when a patient has multiple coverages
COB is the process that determines the order in which multiple insurers pay claims to prevent duplicate payment.
Question 7: Which 837 transaction set is used to submit professional (physician) claims electronically?
- 837I
- 837P (Correct answer)
- 835
- 270
Correct answer: 837P
The 837P transaction is the HIPAA-standard electronic format for submitting professional/physician claims.
PAR Revenue Cycle Fundamentals 2
Which step in the revenue cycle occurs BEFORE a patient receives services?