REVENUE CYCLE TEST REVIEW
EXAM QUESTIONS WITH DETAILED
ANSWERS 2026
Explain the "Business Record rule". - ANSWERSAdmissible as evidence in court as the
documentation occurs in the normal course of business and is recorded by authorized,
qualified individuals concomitantly with the care provided.
How does the lack of documentation of an event impact the care provided and
reimbursement? - ANSWERSIf the event it is not documented it is deemed to not have
occurred. If the event it is not documented, or the documentation does not support the
charges, the provider is not entitled to be paid for the service.
How is the DRG derived? - ANSWERSFrom the diagnoses and procedure codes
assigned at discharge
List the two front end activities involved in providing clinical services. -
ANSWERSDocumenting the services provided and the charge for the services
What are quality data standards? - ANSWERSRules that define how data is collected,
recorded, edited and retained.
What are the categories of outstanding patient accounts that should be tracked? -
ANSWERSPatients still being treated; patients whose encounter has ended (been
discharged) but not billed.; bills (claims) on hold due to errors; bills (claims) that have
been denied.
What are the components of the Revenue Cycle as it applies to all healthcare facilities?
- ANSWERSPatient intake, clinical services, charge capture, billing and collections
What are the desired outcomes of any revenue cycle activity? - ANSWERSIncreasing
revenue, speeding billing, increasing the rate or volume of collections
What are the differences in Data Governance and Information governance? -
ANSWERSData governance deals with the quality and integrity of data within an
organization, wherever and however data are collected, transmitted and stored.
Information governance establishes a comprehensive platform for effective and efficient
management of the information lifecycle
, What essential data quality internal control functions does HIM perform? -
ANSWERSValidation of certain data elements such as physician identifiers, patient
gender and admit diagnosis
What are the key issues in making benchmarking meaningful? - ANSWERSComparing
peer providers, providers of the same size and type
Who is the "data integrity gatekeeper" of the revenue cycle? Why? - ANSWERSThe
patient access department. Data is collected and recorded at the point of registration
and drives the controls later in the process
What role does Medical Staff Services play in the revenue cycle? - ANSWERSAs the
gateway to physician data, they must accurately maintain provider identification data
What is the traditional role of the HIM professional in the revenue cycle? -
ANSWERSEnsuring that the proper diagnosis and procedure codes are applied for
billing
What is the purpose for a waiting period before billing? - ANSWERSReconciliation of
activities versus charges, to make any needed corrections, and to apply codes.
What is medical necessity? - ANSWERSA set of criteria used by the payer to determine
the level of care it will reimburse
What is case mix index? - ANSWERSThe weighted average of the weights of the
diagnosis related groups assigned upon discharge
What is a consequence of the failure to correct billing errors? - ANSWERSReduced
payment from the payer, possibly no payment
In the outpatient setting what tool may be helpful to reduce denied claims? -
ANSWERSPayer specific lists of medical necessity requirements
What are the implications of assigning a duplicate medical record number? -
ANSWERSIt may prevent caregivers from having access to prior test results and clinical
information. It is a quality of care and patient safety issue. It can prevent the provider
from identifying previous collection issues.
Accounts Receivable, A/R, is a key function of which department? - ANSWERSPatient
Financial Services
Describe the difference in direct costs and indirect costs. - ANSWERSDirect costs are
traceable to a specific cost object. Indirect costs cannot be traced to a given cost object
with a method of assignment,
EXAM QUESTIONS WITH DETAILED
ANSWERS 2026
Explain the "Business Record rule". - ANSWERSAdmissible as evidence in court as the
documentation occurs in the normal course of business and is recorded by authorized,
qualified individuals concomitantly with the care provided.
How does the lack of documentation of an event impact the care provided and
reimbursement? - ANSWERSIf the event it is not documented it is deemed to not have
occurred. If the event it is not documented, or the documentation does not support the
charges, the provider is not entitled to be paid for the service.
How is the DRG derived? - ANSWERSFrom the diagnoses and procedure codes
assigned at discharge
List the two front end activities involved in providing clinical services. -
ANSWERSDocumenting the services provided and the charge for the services
What are quality data standards? - ANSWERSRules that define how data is collected,
recorded, edited and retained.
What are the categories of outstanding patient accounts that should be tracked? -
ANSWERSPatients still being treated; patients whose encounter has ended (been
discharged) but not billed.; bills (claims) on hold due to errors; bills (claims) that have
been denied.
What are the components of the Revenue Cycle as it applies to all healthcare facilities?
- ANSWERSPatient intake, clinical services, charge capture, billing and collections
What are the desired outcomes of any revenue cycle activity? - ANSWERSIncreasing
revenue, speeding billing, increasing the rate or volume of collections
What are the differences in Data Governance and Information governance? -
ANSWERSData governance deals with the quality and integrity of data within an
organization, wherever and however data are collected, transmitted and stored.
Information governance establishes a comprehensive platform for effective and efficient
management of the information lifecycle
, What essential data quality internal control functions does HIM perform? -
ANSWERSValidation of certain data elements such as physician identifiers, patient
gender and admit diagnosis
What are the key issues in making benchmarking meaningful? - ANSWERSComparing
peer providers, providers of the same size and type
Who is the "data integrity gatekeeper" of the revenue cycle? Why? - ANSWERSThe
patient access department. Data is collected and recorded at the point of registration
and drives the controls later in the process
What role does Medical Staff Services play in the revenue cycle? - ANSWERSAs the
gateway to physician data, they must accurately maintain provider identification data
What is the traditional role of the HIM professional in the revenue cycle? -
ANSWERSEnsuring that the proper diagnosis and procedure codes are applied for
billing
What is the purpose for a waiting period before billing? - ANSWERSReconciliation of
activities versus charges, to make any needed corrections, and to apply codes.
What is medical necessity? - ANSWERSA set of criteria used by the payer to determine
the level of care it will reimburse
What is case mix index? - ANSWERSThe weighted average of the weights of the
diagnosis related groups assigned upon discharge
What is a consequence of the failure to correct billing errors? - ANSWERSReduced
payment from the payer, possibly no payment
In the outpatient setting what tool may be helpful to reduce denied claims? -
ANSWERSPayer specific lists of medical necessity requirements
What are the implications of assigning a duplicate medical record number? -
ANSWERSIt may prevent caregivers from having access to prior test results and clinical
information. It is a quality of care and patient safety issue. It can prevent the provider
from identifying previous collection issues.
Accounts Receivable, A/R, is a key function of which department? - ANSWERSPatient
Financial Services
Describe the difference in direct costs and indirect costs. - ANSWERSDirect costs are
traceable to a specific cost object. Indirect costs cannot be traced to a given cost object
with a method of assignment,
