CHFP Study Set - Revenue Cycle Questions And 100%
Correct Answers
Accounts Receivable Collection Period - Answer number of days in the accounting
period divided by accounts receivable turnover; this ratio indicates on average, how
long it takes to collect amounts due
ABN Advance Beneficiary Notice - Answer the mandated form required to be given to
Medicare beneficiaries related to non-covered outpatient services; waiver that a
provider has a patient sign confirming the patient's understanding that certain provided
services may not be reimbursable under Medicare and therefore are the patient's
responsibility; provider may not collect if this form was not presented and signed. Two
copies - original for provider & copy for patient or representative.
Allowed Amount - maximum amount Medicare will pay in a given area for a covered
service
Ambulatory Patient Group (APG), Ambulatory Payment Classification (APC) -
institutional outpatient reimbursement system based on methodology developed by
CMS; these are to outpatient visits/Services what the MS-DRGs are to inpatient hospital
admissions; the payments are based on categories or groupings of like or similar
services
APR-DRG - All patient refined DRG is a software developed by 3M to identify and classify
members into clinically meaningful categories based on disease(s), disease
progression, severity of illness and risk of mortality of a payors' population
Assignment - A patient's agreement that assigns to the provider the right to receive
payment from a third party for the service provided to the patient
Capitation - Payment method under which selected health services are paid for on the
basis of a fixed rate per eligible member without regard to the actual number or nature
, of services provided to each enrollee; typically paid per member per month
Charge description master or chargemaster (AKA CDM) - A file that contains a list of
chargeable services and associated prices
Hard Cost - Answer Loss of future revenue (of dissatisfied patients; likely precipitated
by a negative experience a patient had, who decides not to return)
Soft Cost - Answer the customer's negative word‐of‐mouth advertising. This may
influence others not to use the hospital.
Patient's Path - Answer Pre-treatment/Access, Treatment, Patient Financial Services
Medical necessity - Answer services that are reasonable and necessary for the
diagnosis and
treatment of an illness or injury and that are not excluded by the Medicare Program.
Medicare Secondary Payor (MSP) - Answer provisions that apply to situations where
Medicare is not the beneficiary's primary insurance.
1. Group Health Plans (Large-disabled, or Employer),
2. Worker's Compensation, and
3. No-Fault or Liability insurance, in case of an accident, are payors that would classify
as Primary putting this payor in the secondary payor position.
Work RVUs - Answers reflect the relative levels of time and intensity associated with
furnishing a PFS service and account for approximately 50 percent of the total payment
by Medicare to a physician.
UB-04 - Answer Uniform Billing Form (Paper Form) - NON-Medicare; being replaced with
837I form
Correct Answers
Accounts Receivable Collection Period - Answer number of days in the accounting
period divided by accounts receivable turnover; this ratio indicates on average, how
long it takes to collect amounts due
ABN Advance Beneficiary Notice - Answer the mandated form required to be given to
Medicare beneficiaries related to non-covered outpatient services; waiver that a
provider has a patient sign confirming the patient's understanding that certain provided
services may not be reimbursable under Medicare and therefore are the patient's
responsibility; provider may not collect if this form was not presented and signed. Two
copies - original for provider & copy for patient or representative.
Allowed Amount - maximum amount Medicare will pay in a given area for a covered
service
Ambulatory Patient Group (APG), Ambulatory Payment Classification (APC) -
institutional outpatient reimbursement system based on methodology developed by
CMS; these are to outpatient visits/Services what the MS-DRGs are to inpatient hospital
admissions; the payments are based on categories or groupings of like or similar
services
APR-DRG - All patient refined DRG is a software developed by 3M to identify and classify
members into clinically meaningful categories based on disease(s), disease
progression, severity of illness and risk of mortality of a payors' population
Assignment - A patient's agreement that assigns to the provider the right to receive
payment from a third party for the service provided to the patient
Capitation - Payment method under which selected health services are paid for on the
basis of a fixed rate per eligible member without regard to the actual number or nature
, of services provided to each enrollee; typically paid per member per month
Charge description master or chargemaster (AKA CDM) - A file that contains a list of
chargeable services and associated prices
Hard Cost - Answer Loss of future revenue (of dissatisfied patients; likely precipitated
by a negative experience a patient had, who decides not to return)
Soft Cost - Answer the customer's negative word‐of‐mouth advertising. This may
influence others not to use the hospital.
Patient's Path - Answer Pre-treatment/Access, Treatment, Patient Financial Services
Medical necessity - Answer services that are reasonable and necessary for the
diagnosis and
treatment of an illness or injury and that are not excluded by the Medicare Program.
Medicare Secondary Payor (MSP) - Answer provisions that apply to situations where
Medicare is not the beneficiary's primary insurance.
1. Group Health Plans (Large-disabled, or Employer),
2. Worker's Compensation, and
3. No-Fault or Liability insurance, in case of an accident, are payors that would classify
as Primary putting this payor in the secondary payor position.
Work RVUs - Answers reflect the relative levels of time and intensity associated with
furnishing a PFS service and account for approximately 50 percent of the total payment
by Medicare to a physician.
UB-04 - Answer Uniform Billing Form (Paper Form) - NON-Medicare; being replaced with
837I form
