REVENUE CYCLE MANAGEMENT QUESTIONS AND ANSWERS (GRADED A+)

REVENUE CYCLE MANAGEMENT
QUESTIONS AND ANSWERS (GRADED
A+)
RCM (Revenue Cycle Management) - ANSWER-The supervision of all administrative
and clinical functions that contribute to the capture, management, and collection of
patient service revenue.
-the purpose is to improve the efficiency and effectiveness of the revenue cycle
process.

RC (Revenue Cycle) - ANSWER-The regular set of tasks and activities producing
revenue for the facility or practice, and the management of that cycle in an acute-care
setting.

TPP - ANSWER-Third-party payer

Preclaims submission activities - ANSWER--comprise tasks and functions from the
patient registration and case management areas.Claim

Claims processing activities - ANSWER--include the capture of all billable services,
claim generation and claim corrections.

Charge Capture - ANSWER--a vital component of the revenue cycle
-order entry
-coding
-charge generation

CDM (Charge Description Master) - ANSWER--a database used by healthcare facilities
to house billing information for all services provided to patients.
-the primary function is to produce hospital claims.

scrubbers - ANSWER-internal auditing systems that run each claim through a set of
edits specifically designed for the various third-party payers. The auditing system
identifies data that have failed edits and flags the claim for correction. (Schnering 131)

AR (Accounts Receivable) - ANSWER--this department manages the amounts owed to
a facility by patients who received services but whose payments will be made at a later
date by the patients or guarantors or their third-party payers.

claims reconciliation & collection - ANSWER--the last component of the revenue cycle
-the facility compares expected reimbursement to the actual reimbursement provided by
the TPP (third-party payer) and patient.