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Revenue Cycle Management

Quiz by Amanda Desuacido

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14 questions
Show answers
  • Q1
    The method employed by the healthcare organization to monitor services rendered, from patient registration and appointment scheduling to the conclusion of payments for services, is known as
    Coding
    Insurance Verification
    Denial Management
    Revenue Cycle Management
    30s
  • Q2
    The medical biller's job after a claim has been successfully submitted to the insurance carrier is to _____ the claim until a response has been obtained from the accountable party and the service has been paid in full.
    cancel
    deny
    appeal
    track
    30s
  • Q3
    Who sets the rules for filing claims, such as which services are covered, the reimbursement rates, and the deadlines for filing and paying claims?
    patient
    the insurance provider
    doctor
    medical biller
    30s
  • Q4
    A _____ is a monthly payment to purchase and continue insurance coverage. A _______ is how much money you must pay before your insurance begins to pay for medical services. A _____ is a flat fee you must pay every time you see the doctor and _______ is a percentage you must pay in addition to other fees.
    Premium, deductible, copay, coinsurance
    Deductible, premium, coinsurance, copay
    Copay, coinsurance, deductible, premium
    Premium, copay, deductible, coinsurance
    30s
  • Q5
    A provider bills $400 for a test. The insurance pays $300 and the patient's responsibility is $23.56. What is the contractual discount and what is the patient's responsibility called?
    $100, coinsurance
    $100, copay
    $76.44, coinsurance
    $76.44, copay
    30s
  • Q6
    What is a clearinghouse and what purpose do they serve?
    Clearinghouses collect patient data in a centralized location to promote interoperability in emergency situations.
    Clearinghouses act as an intermediary between insurances and providers to submit electronic claims.
    Clearinghouses distribute payments to providers from third party payers.
    Clearinghouses provide collections services for patients who have not paid their bill.
    30s
  • Q7
    If a patient has both Medicare and Aetna, which insurance do you bill?
    Medicare first, then Aetna. Medicare will send an RA to Aetna for COB.
    Determine which insurance is primary and bill that first.
    Aetna first, then Medicare because private insurance should always be billed first.
    Check the patient's insurance card for instructions.
    30s
  • Q8
    ICD-10 codes are used:
    as diagnosis codes
    All of the above
    as procedure codes
    in DRGs
    30s
  • Q9
    Electronic claims are submitted by means of:
    fax transmission.
    electronic data interchange (EDI)
    the US Postal Service.
    phone transmission. .
    30s
  • Q10
    is an electronic tool that enables organizations to file a complaint against a noncompliant covered entity that is negatively affecting the efficient processing of claims.
    HHS Tool
    Centers for Medicare & Medicaid Services Module
    Administrative Simplification Enforcement Tool (ASET)
    HIPAA Kit
    30s
  • Q11
    Under HIPAA, data elements that are used uniformly to document why patients are seen (diagnosis) and what is done to them during their encounter (procedure) are known as:
    information elements.
    National Standard Format (NSF)
    medical code sets.
    transaction and code set (TCS) standards.
    30s
  • Q12
    A report that is generated by a payer and sent to the provider to show how many claims were received as electronic claims and how many of the claims were automatically rejected and will not be processed is called a:
    send-and-receive file report.
    scrubber report.
    rejection analysis report.
    transaction transmission summary.
    30s
  • Q13
    A patient’s Medicaid eligibility may be verified by:
    real-time online access via the internet.
    all of the above
    verification by telephone with an automated voice response system.
    point-of-service machine.
    30s
  • Q14
    When a Medicaid patient requires a piece of durable medical equipment, the physician must:
    instruct the patient on how to use the equipment.
    obtain prior authorization, preferably written.
    give the name and address of where to purchase the equipment
    write a prescription. .
    30s

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