Chapter 9 Test

Which of the following is the definition of revenue cycle management?

Coordination of all administrative and clinical functions that contribute to the capture, management, and collection of patient service revenue

What is the name of the notice sent after the provider files a claim that details amounts billed by the provider, amounts approved by the payer, how much the payer paid, and what the patient must pay?

EOB

In a typical acute-care setting, admitting is located in which revenue cycle area?

Pre-claims submission

In healthcare settings, the record of the cash the facility will receive for the service it has provided is known as which of the following terms?

Accounts receivable

The amount of money owed a healthcare facility when claims are pending is called?

Dollars in accounts receivable

The remittance advice is provided to which party?

Facility

In a typical acute-care setting, aging of accounts reports are monitored in which revenue cycle area?

Accounts receivable

In regard to accounts receivable management, the older the account or the longer the account remains unpaid the less of a chance that the facility will receive reimbursement for the encounter.

True

The difference between what is charged and what is paid is known as?

Contractual allowance

The term "soft coding" refers to?

CPT codes that are coded by the coder

Which is a characteristic of the "old" RCM approach?

Silo mentality

When revenue cycle analysts examine MS-DRG relationships reporting they examine MS-DRG families for differences in_________ reporting?

Complication/comorbidity

In a typical acute-care setting, patient education of payment policies is located in which revenue cycle area?

Pre-claims submission

Which of the following is not a benefit of an integrated revenue cycle?

Separation of physician practices

In a typical acute-care setting, the explanation of benefits, Medicare summary notice, and remittance advice documents (provided by the payer) are monitored in which revenue cycle area?

Claims reconciliation/collections

Which type of compliance guidance is used by Medicare to communicate policies and procedures for the specific prospective payment systems manuals?

Medicare Claims Processing Manual

Which entity is responsible for processing Part A claims and hospital-based Part B claims for institutional services on behalf of Medicare?

Medicare Administrative Contractor

Which type of compliance is used by Medicare to describe the circumstances under which specific medical supplies, services or procedures are covered nationwide by Medicare?

National Coverage Determinations

Which of the following is not a use of the CDM?

Coder productivity

Which of the following is not a function area of the revenue cycle?

Cafeteria

The dollar amount the facility actually bills for the services it provides is known as?

Charge

Which of the following CDM data element is nationally recognized?

Revenue code

In a typical acute-care setting, charge entry is located in which revenue cycle area?

Claims processing

Which of the following is not used to reconcile accounts in the patient accounting department?

Medicare code editor

In a typical acute-care setting, which revenue cycle area uses an internal auditing system (scrubber) to ensure that error free claims (clean claims) are submitted to third-party payers?

Claims processing

Scrubbers are used by hospitals to identify which of the following errors that can cause claims rejection or denials?

All of the above

All of the following elements are found in a charge description master, except?

ICD-10-CM code

Most facilities begin counting days in accounts receivable at which of the following times?

The date the bill drops

Which of the following compliance documents services as day-to-day operating instructions for administering CMS programs?

CMS program transmittals

There are nationally recognized rules regarding the use of charge descriptions for CPT codes in the CDM?

False