PAR Revenue Cycle Fundamentals 2

Question 1

Which step in the revenue cycle occurs BEFORE a patient receives services?

Accepted Answer

Pre-authorization

Answer

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?

Accepted Answer

A claim that contains all required information and passes edits without errors

Answer

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?

Accepted Answer

Medicare

Answer

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%?

Accepted Answer

The patient

Answer

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)?

Accepted Answer

To explain how a claim was processed and what the payer paid

Answer

A remittance advice explains the payer's adjudication of a claim, including payments, adjustments, and denial reasons.

(PAR) Patient Access Representative Certification Practice Test