Revenue Cycle Management Flashcards
7 cards from real RHIT practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Revenue Cycle Management flashcards as text
Which term describes the process of verifying a patient's insurance coverage before providing services?
Answer: Eligibility verification
Eligibility verification confirms a patient's active insurance coverage and benefits before services are rendered.
A claim is denied because the procedure code does not match the diagnosis code. This is an example of which type of edit?
Answer: National Correct Coding Initiative (NCCI) edit
NCCI edits prevent improper payment of procedures that should not be billed together or when a procedure is incompatible with the diagnosis.
What is the purpose of a charge description master (CDM)?
Answer: To list all billable services with corresponding codes and prices
The CDM (chargemaster) is a comprehensive list of services, procedures, and supplies with associated billing codes and prices used for claim generation.
Which federal program uses the Inpatient Prospective Payment System (IPPS) for hospital reimbursement?
Answer: Medicare
Medicare uses IPPS to reimburse acute care hospitals a predetermined rate based on the patient's MS-DRG assignment.
A hospital receives payment less than the billed amount with an explanation listing contractual adjustments. What should the HIM professional do with the difference?
Answer: Write it off as a contractual adjustment
Contractual adjustments represent the difference between billed charges and the negotiated rate and must be written off per the payer contract.
Which metric measures the average number of days it takes to collect payment after a service is provided?
Answer: Accounts receivable days (AR days)
AR days (days in accounts receivable) measures the average time from service delivery to payment receipt, with lower values indicating faster collections.
When a payer recoup funds previously paid to a provider due to an audit finding, this action is called a:
Answer: Overpayment recovery or clawback
Overpayment recovery (clawback) occurs when a payer demands return of funds after determining a claim was paid incorrectly.