CHAPTER 4: REVENUE CYCLE
MANAGEMENT EXAM QUESTIONS AND
ANSWERS 100% CORRECT
Which means that the patient and/or insured has authorized the payor to reimburse the
provider directly? - ANSWER-Assignment of benefits
Providers who do not accept assignment of Medicare benefits do not receive
information included on the ______________, which is sent to the patient. - ANSWER-
Medical Summary Notice
The transmission of claims data to payers or clearinghouses is called claims -
ANSWER-submission
A patient received services on April 5, totaling $1,000. He paid a $90 coinsurance at the
time services were rendered. (The payer required the patient to pay a 20% coinsurance
of the reasonable charge at the time services were provided). The physician accepted
assignment, and the insurance company established the reasonable charge as $450.
On July 1, the provider received $360 from the insurance company. On August 1, the
patient received a check from the insurance company in the amount of $450. The
overpayment was ____________, and the ____________ must reimburse the
insurance company. - ANSWER-$450, patient
A series of fixed-length records submitted to payers to bill for health care services is an
electronic - ANSWER-flat file format
Which is considered a covered entity? - ANSWER-Private-sector payers that process
electronic claims
A claim that is rejected because of an error or omission is considered a(n) - ANSWER-
open claim
The chargemaster is a(n) - ANSWER-computer-generated list used by facilities, which
contains procedures, services, supplies, revenue codes, and charges
Which supporting documentation is associated with submission of an insurance claim? -
ANSWER-Claims attachment
Which is a group health insurance policy provision that prevents multiple payers from
reimbursement benefits covered by other policies? - ANSWER-Coordination of benefits
, The sorting of claims upon submission to collect and verify information about the patient
and provider is called claims - ANSWER-processing
Which of the following steps would occur first? - ANSWER-Health insurance specialist
completes electronic or paper-based claim
Comparing the claim to payer edits and the patient's health plan benefits is part of
claims - ANSWER-adjudication
Which describes any procedure or service reported on a claim that is not included on
the payer's master benefit list? - ANSWER-Noncovered benefit or exclusion
Which is an abstract of all recent claims filed on each patient, used by the payer to
determine whether the patient is receiving concurrent care for the same condition by
more than one provider? - ANSWER-Common data file
Which is the fixed amount patients pay each time they receive health care services? -
ANSWER-Copayment
Which of the following steps would occur first? - ANSWER-Clearinghouse transmits
claims data to payers
Which must accept whatever a payer reimburses for procedures or services performed?
- ANSWER-Participating provider
Which is an interpretation of the birthday rule regarding two group health insurance
policies when the parents of a child covered on both policies are married to each other
and live in the same household? - ANSWER-The parent whose birth month and day
occurs earlier in the calendar year is the primary policyholder
Computer-generated list of procedures, services, and supplies with charges for each /
financial record source document usually generated by a hospital - ANSWER-
Chargemaster
Which requires providers to make certain written disclosures concerning all finance
charges and related aspects of credit transactions? - ANSWER-Truth in Lending Act
Which protects information collected by consumer reporting agencies? - ANSWER-Fair
Credit Reporting Act
Which is the best way to prevent delinquent claims? - ANSWER-Verify health plan
identification information on all patients
Which is a characteristic of delinquent commercial claims awaiting payer
reimbursement? - ANSWER-The delinquent claims are resolved directly with the payer
MANAGEMENT EXAM QUESTIONS AND
ANSWERS 100% CORRECT
Which means that the patient and/or insured has authorized the payor to reimburse the
provider directly? - ANSWER-Assignment of benefits
Providers who do not accept assignment of Medicare benefits do not receive
information included on the ______________, which is sent to the patient. - ANSWER-
Medical Summary Notice
The transmission of claims data to payers or clearinghouses is called claims -
ANSWER-submission
A patient received services on April 5, totaling $1,000. He paid a $90 coinsurance at the
time services were rendered. (The payer required the patient to pay a 20% coinsurance
of the reasonable charge at the time services were provided). The physician accepted
assignment, and the insurance company established the reasonable charge as $450.
On July 1, the provider received $360 from the insurance company. On August 1, the
patient received a check from the insurance company in the amount of $450. The
overpayment was ____________, and the ____________ must reimburse the
insurance company. - ANSWER-$450, patient
A series of fixed-length records submitted to payers to bill for health care services is an
electronic - ANSWER-flat file format
Which is considered a covered entity? - ANSWER-Private-sector payers that process
electronic claims
A claim that is rejected because of an error or omission is considered a(n) - ANSWER-
open claim
The chargemaster is a(n) - ANSWER-computer-generated list used by facilities, which
contains procedures, services, supplies, revenue codes, and charges
Which supporting documentation is associated with submission of an insurance claim? -
ANSWER-Claims attachment
Which is a group health insurance policy provision that prevents multiple payers from
reimbursement benefits covered by other policies? - ANSWER-Coordination of benefits
, The sorting of claims upon submission to collect and verify information about the patient
and provider is called claims - ANSWER-processing
Which of the following steps would occur first? - ANSWER-Health insurance specialist
completes electronic or paper-based claim
Comparing the claim to payer edits and the patient's health plan benefits is part of
claims - ANSWER-adjudication
Which describes any procedure or service reported on a claim that is not included on
the payer's master benefit list? - ANSWER-Noncovered benefit or exclusion
Which is an abstract of all recent claims filed on each patient, used by the payer to
determine whether the patient is receiving concurrent care for the same condition by
more than one provider? - ANSWER-Common data file
Which is the fixed amount patients pay each time they receive health care services? -
ANSWER-Copayment
Which of the following steps would occur first? - ANSWER-Clearinghouse transmits
claims data to payers
Which must accept whatever a payer reimburses for procedures or services performed?
- ANSWER-Participating provider
Which is an interpretation of the birthday rule regarding two group health insurance
policies when the parents of a child covered on both policies are married to each other
and live in the same household? - ANSWER-The parent whose birth month and day
occurs earlier in the calendar year is the primary policyholder
Computer-generated list of procedures, services, and supplies with charges for each /
financial record source document usually generated by a hospital - ANSWER-
Chargemaster
Which requires providers to make certain written disclosures concerning all finance
charges and related aspects of credit transactions? - ANSWER-Truth in Lending Act
Which protects information collected by consumer reporting agencies? - ANSWER-Fair
Credit Reporting Act
Which is the best way to prevent delinquent claims? - ANSWER-Verify health plan
identification information on all patients
Which is a characteristic of delinquent commercial claims awaiting payer
reimbursement? - ANSWER-The delinquent claims are resolved directly with the payer
