Revenue Chapter 9 Review Quiz

  1. Which provider order entry is usually more reliable, paper based or electronic & why?
    Electronic, everything is entered directly into the patient's record, less chance of human error because the information is handled once.
  2. What are 2 sources of new charge description master codes?
    AMA & CMS both provide long & short descriptions of the CPT/HCPCS codes. The facility itself may modify the description to fit their need.
  3. What risk areas are concerns when charge description master is not maintained and revised?
    Code changes take place quarterly and annually. If the CDM doesn't match the current codes, then claims could be filled wrong & the facility might not be in compliance with regulations.
  4. How has HIPAA changed claims processing?
    Claims are processed electronically , which is faster than by mail. It also allowed CMS to standardize billing nationally.
  5. What are 2 roles of EDI (Electronic Data Interchange)?
    EOBs (Explanation of Benefits) & MSN (Medicare Summary Notice) are both done through EDI as well as RA (Remittance Advice).
  6. List ways that discrepancies between submitted charges & paid charges are reconciled by the provider.
    EOBs, MSNs & RAs are compared with the claim to see if there is an error so that the error may be corrected.
  7. How do providers decide what optimal performance is for units of their facility?
    MAP keys or KPIs (Key Performance Indicators)
  8. Facility B just completed an analysis of its alarming high balance of unpaid claim amounts. What are some KPIs a provider's RCM team could use to learn the reason(s) for the surge in unpaid balances?
    Aged AR, denial write offs, discharged not submitted, discharged not final billed, service authorization rate, insurance verification.
  9. Describe at least 3 sources of errors that causes claim denials.
    Human error, incompatible dates of service, nonspecific or incorrect diagnosis & procedure codes, lack of medical necessity, incorrect revenue code assignment.
  10. T or F Use of CDM has made manual coding by HIM coders obsolete.
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Revenue Chapter 9 Review Quiz