RHIT Revenue Cycle Management 3

Question 1

Which document sent by the payer details what was paid, denied, or adjusted on a claim?

Accepted Answer

Explanation of Benefits (EOB) / Remittance Advice (RA)

Answer

Advance Beneficiary Notice (ABN)

Answer

Notice of Claim Adjudication (NCA)

Answer

Medicare Summary Notice (MSN)

Question 2

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:

Accepted Answer

Coordination of benefits (COB)

Answer

Subrogation

Answer

Dual eligibility determination

Answer

Secondary claim processing

Question 3

Under the MS-DRG system, what is the primary factor that determines a patient's DRG assignment?

Accepted Answer

Principal diagnosis with complications/comorbidities (CCs/MCCs)

Answer

Length of stay

Answer

Number of procedures performed

Answer

Attending physician specialty

Question 4

Which type of audit is conducted by Recovery Audit Contractors (RACs) to identify Medicare improper payments?

Accepted Answer

Retrospective (post-payment) audit

Answer

Prospective audit

Answer

Concurrent audit

Answer

Internal compliance audit

Question 5

A claim submitted without errors that meets all payer requirements on its first submission is called a:

Accepted Answer

Clean claim

Answer

Accepted claim

Answer

Certified claim

Answer

Pre-adjudicated claim

Question 6

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?

Accepted Answer

OGCR Section II guideline

Answer

UHDDS guidelines

Answer

POA indicator rule

Answer

Discharge disposition rule

Question 7

Which of the following is an example of a front-end revenue cycle function?

Accepted Answer

Patient registration and insurance verification

Answer

Claim submission

Answer

Denial management

Answer

Payment posting