In healthcare settings, the record of the cash the facility will receive for the services it has provided is known as
Accounts Receivable
What is a characteristic of the"old" RCM approach?
Silo mentality
Which of the following CDM data elements is nationally recognized?
Revenue code
In a typical acute care setting, Charge Entry is located in which revenue cycle area?
Claims processing
Scrubbers are used by hospitals to identify which of the following errors that can cause claim rejections or denials.
All of the above
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 & what the patient must pay?
EOB (Explanation of Benefits)
Which of the following is not a function area of the revenue cycle?
Cafeteria
The term"soft coding" refers to
CPT/HCPCS codes that are coded by coders
Which of the following compliance documents services day to day operating instructions for administering CMS programs?
Medicare Claims Processing Manual
The difference between what is charged & what is paid is known as
Contractual allowance
All of the following elements are found in a CDM except
ICD-10-CM code
Which type of compliance guidance is used by Medicare to describe the circumstances under which specific medical supplies, services or procedures are covered nationwide by Medicare?
National coverage
Which entity is responsible for processing Part A & hospital based Part B claims for institutional services on behalf of Medicare.
MAC (Medicare Administrative Contractor)
In a typical acute care setting, Admitting is located in which revenue cycle area?
Pre-claims submission
Which of the following is the definition of revenue cycle management?
Coordination of all administrative & clinical functions that contribute to the capture, management & collection of patient service revenue.
In a typical acute care setting, the EOB, MSN, & the RA 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 & procedures for the prospective payment systems' manual?
CMS Program Transmittals
The amount of money owed a healthcare facility when claims are pending is called
Dollars in AR
Which of the following is not a benefit of an integrated revenue cycle?
Separation of physician practices
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 3rd party payers?
Claims processing
When revenue cycle analyst examine MS-DRG relationships reporting they examine MS-DRG families for differences _____ reporting.
Complication/comorbidity
In a typical acute care setting, Aging of Accounts reports are monitored in which revenue cycle area?
Accounts Receivable
T or F There are nationally recognized rules regarding the use of charge descriptions for CPT codes in the CDM.
False
T or F In regards to AR 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 dollar amount the facility actually bills for the services it provides is known as
Charge
Most facilities begin counting days in accounts receivable at which of the following times?
The date the bill drops
The RA is provided to which party?
Both A & B Patient & facility
Which of the following is not used to reconcile accounts in the patient accounting department?
Medicare Code Editor
In a typical acute care setting, Patient Education of Payment Policies is located in which revenue cycle area?
