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

The EOB/RA is the document payers send to providers detailing payment decisions, adjustments, and denial reasons for submitted claims.

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

Coordination of benefits establishes payment order when a patient has multiple insurance coverages to prevent overpayment.

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

MS-DRG assignment is driven primarily by the principal diagnosis and the presence of complications or comorbidities (CC/MCC) that affect resource use.

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

RAC audits are retrospective, reviewing claims already paid by Medicare to identify overpayments or underpayments.

Question 5

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

Accepted Answer

Clean claim

Answer

A clean claim contains all required data elements, no errors, and is accepted for adjudication without additional information requests.

RHIT - Registered Health Information Technician Practice Test

RHIT - Registered Health Information Technician Practice Test

RHIT Revenue Cycle Management 3