RHIT Revenue Cycle Management 2

Question 1

Which term describes the process of verifying a patient's insurance coverage before providing services?

Accepted Answer

Eligibility verification

Answer

Claim adjudication

Answer

Prior authorization

Answer

Remittance posting

Question 2

A claim is denied because the procedure code does not match the diagnosis code. This is an example of which type of edit?

Accepted Answer

National Correct Coding Initiative (NCCI) edit

Answer

Duplicate claim edit

Answer

Medical necessity edit

Answer

Medically unlikely edit (MUE)

Question 3

What is the purpose of a charge description master (CDM)?

Accepted Answer

To list all billable services with corresponding codes and prices

Answer

To record patient demographic information

Answer

To track denied claims by payer

Answer

To document physician credentials

Question 4

Which federal program uses the Inpatient Prospective Payment System (IPPS) for hospital reimbursement?

Accepted Answer

Medicare

Answer

Medicaid

Answer

TRICARE

Answer

CHIP

Question 5

A hospital receives payment less than the billed amount with an explanation listing contractual adjustments. What should the HIM professional do with the difference?

Accepted Answer

Write it off as a contractual adjustment

Answer

Bill the patient for the remainder

Answer

Resubmit the claim to the payer

Answer

Escalate to the compliance officer

Question 6

Which metric measures the average number of days it takes to collect payment after a service is provided?

Accepted Answer

Accounts receivable days (AR days)

Answer

Clean claim rate

Answer

Denial rate

Answer

Net collection rate

Question 7

When a payer recoup funds previously paid to a provider due to an audit finding, this action is called a:

Accepted Answer

Overpayment recovery or clawback

Answer

Coordination of benefits

Answer

Secondary billing

Answer

Claim adjustment