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

Prior authorization is a process used by payers to determine if a service is medically necessary and covered before it is performed. Failing to secure a required prior authorization for a service typically leads to the payer denying the claim for that service, potentially leaving the provider with uncompensated care or making the patient responsible for the cost.

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

The Charge Description Master (CDM), or chargemaster, is a comprehensive list of all items billable to a patient or their insurance provider. It is a foundational component of the revenue cycle that translates services, supplies, and procedures into billable line items with corresponding codes (like CPT/HCPCS), revenue codes, and prices.

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

NCCI PTP edits are designed to prevent improper payment by bundling services that are considered components of a more comprehensive service or by identifying code pairs that are mutually exclusive and should not be billed together for the same patient on the same day. A denial based on a PTP edit indicates an incorrect combination of procedure codes was submitted.

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

A Remittance Advice (RA) is sent from a payer to a provider to explain how a claim was processed. A contractual adjustment represents the difference between the provider's full charge and the amount allowed by the payer's contract. This amount is not a denial and should be posted and written off. It is not billable to the patient.

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

Days in Accounts Receivable (A/R) is a critical financial metric that calculates the average time it takes for a provider to receive payment after a service has been provided. A lower number of days is preferable as it indicates an efficient billing and collection process and a healthy cash flow.

RHIT - Registered Health Information Technician Practice Test

RHIT - Registered Health Information Technician Practice Test

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