RHIT - Registered Health Information Technician Revenue Cycle Management Questions and Answers

Question 1

A patient is scheduled for a non-emergent MRI.
The registration staff discovers that the patient's insurance plan requires pre-approval for this service.
Failure to obtain this approval before the service is rendered will MOST likely result in which of the following?

Accepted Answer

A claim denial for lack of prior authorization.

Answer

An automatic charge adjustment by the provider.

Answer

A request for additional medical records from the payer.

Answer

A delay in patient scheduling only.

Question 2

What is the primary function of the Charge Description Master (CDM) in the revenue cycle?

Accepted Answer

To link billable services and supplies to specific CPT/HCPCS codes and associated prices.

Answer

To manage patient demographic and insurance information.

Answer

To submit electronic claims to a clearinghouse.

Answer

To sequence diagnosis codes according to UHDDS guidelines.

Question 3

A claim for a Medicare patient is denied due to a National Correct Coding Initiative (NCCI) 'procedure-to-procedure' (PTP) edit. Which of the following is the most likely reason for this denial?

Accepted Answer

Two procedures were billed that are considered mutually exclusive or one is a component of the other.

Answer

The patient's insurance was not active on the date of service.

Answer

The diagnosis code did not support the medical necessity of the procedure.

Answer

The claim was submitted on the wrong form type (e.g., UB-04 instead of CMS-1500).

Question 4

A hospital's business office receives a Remittance Advice (RA) showing that a claim was paid at a lower rate than expected due to a contractual adjustment. What is the most appropriate next step in the payment posting process?

Accepted Answer

Post the payment and write off the difference as a contractual adjustment per the payer contract.

Answer

Immediately bill the patient for the full remaining balance.

Answer

Resubmit the original claim without any changes.

Answer

Appeal the claim as a wrongful denial with the insurance company.

Question 5

A revenue cycle director is tracking the facility's performance. Which key performance indicator (KPI) measures the average number of days it takes for the facility to collect payments for services rendered?

Accepted Answer

Days in Accounts Receivable (A/R)

Answer

Clean Claim Rate

Answer

Net Collection Rate

Answer

Denial Rate

Question 6

Before a claim is submitted to a third-party payer, it is often processed by internal software that checks for errors, such as missing data, incorrect code combinations, and payer-specific formatting issues. This process is known as:

Accepted Answer

Claims scrubbing

Answer

Claims adjudication

Answer

Remittance advice review

Answer

Charge reconciliation