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 document sent by the payer details what was paid, denied, or adjusted on a claim?
Answer: Explanation of Benefits (EOB) / Remittance Advice (RA)
The EOB/RA is the document payers send to providers detailing payment decisions, adjustments, and denial reasons for submitted claims.
A patient is covered by both a spouse's employer plan and their own employer plan. The process of determining which payer pays first is called:
Answer: Coordination of benefits (COB)
Coordination of benefits establishes payment order when a patient has multiple insurance coverages to prevent overpayment.
Under the MS-DRG system, what is the primary factor that determines a patient's DRG assignment?
Answer: Principal diagnosis with complications/comorbidities (CCs/MCCs)
MS-DRG assignment is driven primarily by the principal diagnosis and the presence of complications or comorbidities (CC/MCC) that affect resource use.
Which type of audit is conducted by Recovery Audit Contractors (RACs) to identify Medicare improper payments?
Answer: Retrospective (post-payment) audit
RAC audits are retrospective, reviewing claims already paid by Medicare to identify overpayments or underpayments.
A claim submitted without errors that meets all payer requirements on its first submission is called a:
Answer: Clean claim
A clean claim contains all required data elements, no errors, and is accepted for adjudication without additional information requests.
Which coding guideline states that when a patient is admitted for a complication of surgery or other medical care, the complication code should be sequenced as the principal diagnosis?
Answer: OGCR Section II guideline
UHDDS/OGCR guidelines for principal diagnosis selection require sequencing the complication as the principal diagnosis when it is the reason for admission.
Which of the following is an example of a front-end revenue cycle function?
Answer: Patient registration and insurance verification
Front-end revenue cycle functions occur before or at the time of service and include scheduling, registration, eligibility verification, and pre-authorization.