Chapter 03 Introduction to Revenue Management-
Complete Exam Study Guide 2026/2027 with
Verified Answers | Newest Version. A+
accept assignment
provider accepts as payment in full whatever is paid on the claim by the payer (except for any
copayment and/or coinsurance amounts).
account payable
amount a business owes creditors and suppliers
account receivable
amount owed to a business for services or goods provided
accounts receivable management
assists providers in the collection of appropriate reimbursement for services rendered; includes
functions such as insurance verification/eligibility and pre-authorization of services.
accrual accounting
method that focuses on anticipated revenue and associated expenses; revenue earned and
expenses billed are recorded even though third-party payer reimbursement has not been
received and expenses have not been paid.
assignment of benefits
the provider receives reimbursement directly from the payer
birthday rule
determines coverage by primary and secondary policies when each parent subscribes to a
different health insurance plan
case management
development of patient care plans to coordinate and provide care for complicated cases in a
cost-effective manner.
charge description master (CDM)
see chargemaster
, chargemaster
computer-generated encounter form that contains a list of procedures, services, supplies, and
revenue codes; chargemaster data are entered in the outpatient hospital facility's patient
accounting system, and charges are automatically posted to the patient's bill (UB-04).
chargemaster maintenance
process of updating and revising key elements of the chargemaster (or charge description
master [CDM]) to ensure accurate reimbursement.
chargemaster team
team of representatives from a variety of departments who jointly share responsibility for
updating and revising the chargemaster to ensure accuracy.
claims denials
unpaid claim returned by third-party payers because of beneficiary identification errors, coding
errors, diagnosis that does not support medical necessity of procedure/service, duplicate
claims, global days of surgery E/M coverage issue, NCCI program edits, and other patient
coverage issues (e.g., procedure or service required preauthorization, procedure is not included
in patient's health plan contract, such as cosmetic surgery).
claims rejections
unpaid claim returned by third-party payers because it fails to meet certain data requirements,
such as missing data (e.g., patient name, policy number); rejected claims can be corrected and
resubmitted for processing.
concurrent review
continued-stay review for continued appropriateness of care and medical necessity of tests and
procedures ordered during an inpatient hospitalization.
Data Analysis
see data analytics
data analytics
tools and systems that are used to analyze (examine and study) clinical and financial data,
conduct research, and evaluate the effectiveness of disease treatments.
data mining
extracting and analyzing data to identify patterns, whether predictable or unpredictable.
Complete Exam Study Guide 2026/2027 with
Verified Answers | Newest Version. A+
accept assignment
provider accepts as payment in full whatever is paid on the claim by the payer (except for any
copayment and/or coinsurance amounts).
account payable
amount a business owes creditors and suppliers
account receivable
amount owed to a business for services or goods provided
accounts receivable management
assists providers in the collection of appropriate reimbursement for services rendered; includes
functions such as insurance verification/eligibility and pre-authorization of services.
accrual accounting
method that focuses on anticipated revenue and associated expenses; revenue earned and
expenses billed are recorded even though third-party payer reimbursement has not been
received and expenses have not been paid.
assignment of benefits
the provider receives reimbursement directly from the payer
birthday rule
determines coverage by primary and secondary policies when each parent subscribes to a
different health insurance plan
case management
development of patient care plans to coordinate and provide care for complicated cases in a
cost-effective manner.
charge description master (CDM)
see chargemaster
, chargemaster
computer-generated encounter form that contains a list of procedures, services, supplies, and
revenue codes; chargemaster data are entered in the outpatient hospital facility's patient
accounting system, and charges are automatically posted to the patient's bill (UB-04).
chargemaster maintenance
process of updating and revising key elements of the chargemaster (or charge description
master [CDM]) to ensure accurate reimbursement.
chargemaster team
team of representatives from a variety of departments who jointly share responsibility for
updating and revising the chargemaster to ensure accuracy.
claims denials
unpaid claim returned by third-party payers because of beneficiary identification errors, coding
errors, diagnosis that does not support medical necessity of procedure/service, duplicate
claims, global days of surgery E/M coverage issue, NCCI program edits, and other patient
coverage issues (e.g., procedure or service required preauthorization, procedure is not included
in patient's health plan contract, such as cosmetic surgery).
claims rejections
unpaid claim returned by third-party payers because it fails to meet certain data requirements,
such as missing data (e.g., patient name, policy number); rejected claims can be corrected and
resubmitted for processing.
concurrent review
continued-stay review for continued appropriateness of care and medical necessity of tests and
procedures ordered during an inpatient hospitalization.
Data Analysis
see data analytics
data analytics
tools and systems that are used to analyze (examine and study) clinical and financial data,
conduct research, and evaluate the effectiveness of disease treatments.
data mining
extracting and analyzing data to identify patterns, whether predictable or unpredictable.
