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 ambulatory payment classification (APC) system is used to reimburse Medicare outpatient hospital services?
Answer: Outpatient Prospective Payment System (OPPS)
OPPS groups outpatient services into APCs and pays a predetermined rate per APC, used by Medicare for hospital outpatient reimbursement.
A hospital's net collection rate is calculated as:
Answer: Payments collected divided by net patient revenue owed
Net collection rate measures the percentage of collectible revenue actually collected, calculated as collections divided by net charges (after contractual adjustments).
When a secondary payer processes a claim after the primary payer has paid, which document is required to show the primary payer's payment?
Answer: The primary payer's EOB/RA
The primary payer's EOB or Remittance Advice must accompany the secondary claim to show what the primary paid, allowing the secondary payer to calculate its liability.
Which modifier is appended to a CPT code to indicate a significant, separately identifiable evaluation and management service was provided on the same day as a procedure?
Answer: -25
Modifier -25 indicates that a significant, separately identifiable E/M service was performed by the same physician on the same day as a procedure or other service.
A hospital's case mix index (CMI) increased from 1.45 to 1.62. What does this indicate?
Answer: The hospital is treating more complex or resource-intensive patients on average
A higher CMI reflects a greater proportion of complex, resource-intensive cases, which generally correlates with higher Medicare reimbursement per case.
Which law created the Medicare and Medicaid programs in the United States?
Answer: Social Security Act of 1965
The Social Security Act of 1965 (Title XVIII and Title XIX) established Medicare and Medicaid as federal health insurance programs.
In value-based purchasing (VBP), hospitals can receive incentive payments or penalties based on which of the following?
Answer: Quality and efficiency performance metrics
VBP ties Medicare reimbursement to quality and efficiency performance measures such as clinical outcomes, patient satisfaction, and cost efficiency.