REVENUE CYCLE MANAGEMENT
CHAPTER 1 WITH CORRECT
SOLUTIONS
Accounts Receivable - ANSWER-The total sum owed to an organization, generally as a
result of services rendered, it is an important component of the measurement of various
revenue cycle monitors.
Revenue Cycle - ANSWER-The series of activities that connect the services rendered
by a healthcare provider with the methods by which the provider receives compensation
for those services
Revenue - ANSWER-The sum earned by the provider, measured in dollars.
Ambulatory payment classification (APC) - ANSWER-Hospital outpatient prospective
payment system (OPPS). The classification is a resource-based reimbursement system.
Bill hold - ANSWER-The waiting period (up to five days for inpatients and up to seven
days for outpatients) that allows the provider to reconcile activities versus charges,
make corrections as needed, and apply any additional diagnostic and procedural
coding.
Bottom line - ANSWER-Net operating revenue- operating revenue minus operating
expenses.
Business record rule - ANSWER-States that a record is admissible as evidence in court
assuming documentation occurs in the normal course of business, is recorded by
authorized, qualified individuals concurrently with the care provided, and there is no
reason to suspect the veracity of the record as presented.
Case-mix index (CMI) - ANSWER-The average relative weight of all cases treated at a
given facility or by a given physician, which reflects the resource intensity or clinical
severity of a specific group in relation to the other groups in the classification system;
calculated by dividing the sum of the weights of diagnosis-related groups for patients
discharged during a given period by the total number of patients discharged.
Charge - ANSWER-A price assigned to a unit of medical or health service. The price is
assigned based on a variety of factors, including cost, payer contracts, and case mix.
Claim - ANSWER-A request for payment for services, benefits, or costs by a hospital,
physician, or other provider that is submitted for reimbursement to the healthcare
insurance plan either by the insured party or by the provider.
CHAPTER 1 WITH CORRECT
SOLUTIONS
Accounts Receivable - ANSWER-The total sum owed to an organization, generally as a
result of services rendered, it is an important component of the measurement of various
revenue cycle monitors.
Revenue Cycle - ANSWER-The series of activities that connect the services rendered
by a healthcare provider with the methods by which the provider receives compensation
for those services
Revenue - ANSWER-The sum earned by the provider, measured in dollars.
Ambulatory payment classification (APC) - ANSWER-Hospital outpatient prospective
payment system (OPPS). The classification is a resource-based reimbursement system.
Bill hold - ANSWER-The waiting period (up to five days for inpatients and up to seven
days for outpatients) that allows the provider to reconcile activities versus charges,
make corrections as needed, and apply any additional diagnostic and procedural
coding.
Bottom line - ANSWER-Net operating revenue- operating revenue minus operating
expenses.
Business record rule - ANSWER-States that a record is admissible as evidence in court
assuming documentation occurs in the normal course of business, is recorded by
authorized, qualified individuals concurrently with the care provided, and there is no
reason to suspect the veracity of the record as presented.
Case-mix index (CMI) - ANSWER-The average relative weight of all cases treated at a
given facility or by a given physician, which reflects the resource intensity or clinical
severity of a specific group in relation to the other groups in the classification system;
calculated by dividing the sum of the weights of diagnosis-related groups for patients
discharged during a given period by the total number of patients discharged.
Charge - ANSWER-A price assigned to a unit of medical or health service. The price is
assigned based on a variety of factors, including cost, payer contracts, and case mix.
Claim - ANSWER-A request for payment for services, benefits, or costs by a hospital,
physician, or other provider that is submitted for reimbursement to the healthcare
insurance plan either by the insured party or by the provider.
