C810- REVENUE CYCLE MANAGEMENT
EXAM QUESTIONS AND ANSWERS
100% ACCURATE
revenue cycle - ANSWER-The _______________ is the process that begins when a
patient comes to a healthcare system for services and includes those activities that
have to occur in order for a provider of the care to bill at the end of the patient's service
encounter.
front end
middle
back end - ANSWER-The revenue management life cycle can be bro-ken down into
three phases?
front end - ANSWER-The _______________ of the revenue cycle includes patient
access functions such as scheduling the patient for services, registration of the patient,
prior or pre-authorization for services, insurance verification, service estimates, and
financial counseling.
Phase 1 of Rev Cycle Management (Front end) - ANSWER-During this phase,
healthcare organizations need to ascertain the source of payment for the service, follow
requirements specified by the payer, accurately collect the patient's demographic
information, and ensure a positive patient experience.
middle process - ANSWER-The ______________ of the revenue cycle includes case
management, capture of charges for the services rendered, and coding for those
services based on clinical documentation.
Phase 2 of Rev Cycle Management (Middle) - ANSWER-The key objectives in this
phase are to manage clinical practice according to accepted medical guidelines, identify
reimbursable services and ensure that documentation supports those services, and
ensure accurate and complete coding of the documented services.
back end - ANSWER-The ________________ of the revenue cycle is the business
office or patient financial service process and includes claims processing and payment
posting, fol-low-up, customer service, collections of unpaid bills, and denial
management.
Phase 3 of Rev Cycle Management (Back end) - ANSWER-In this phase, organizations
focus on releasing claims to the payers as quickly as possible after service is rendered
and generating accurate and complete claims resulting in reimbursement of the amount
expected by the payer.
, Front end process - ANSWER-Payor negotiation and renegotiation; patient access,
including scheduling, pre-authorization, insurance verification, point-of-service
collection, and financial counseling are all examples of which process of the Rev Cycle?
Middle process - ANSWER-Charge capture, case management, clinical documentation,
and coding are all examples of which process of the Rev Cycle?
Back end process - ANSWER-Claims processing and payment posting, follow-up,
customer service, collections, and denial management are all examples of which
process of the Rev Cycle?
scheduling and Registration - ANSWER-Staff responsible for _________________ and
____________________ functions requires a significant amount of knowledge
regarding the medical services provided, insurance carrier requirements, provider
preferences, and operational hours of services to be rendered.
Resources to support specific requirements include?
preregistration
insurance eligibility
benefit verification
payer authorizations
pre-service collections - ANSWER-The Pre Encounter Centers handle?
management of contracts - ANSWER-The ____________________ is an integral part
of the revenue cycle.
allowable costs
chargeable services
supplies provided by a hospital or physician - ANSWER-Healthcare facilities negotiate
contract terms with third-party insurers for payment of services rendered to patients.
This is where __________________, ____________________, and
________________________ that qualify as covered expenses are defined.
Contract management - ANSWER-__________________________ has its own life
cycle and contract managers need to have an understanding of competitor and local
market rates in order to negotiate reasonable reimbursement rates that cover the
health-care organization's expenses, while remaining competitive.
forecast | calculate | capture - ANSWER-Hospitals and healthcare systems need to
accurately ____________, _____________, and _____________ all net revenue
contractually owed to them from payers and patients.
case management - ANSWER-A collaborative practice model including patients,
nurses, social workers, physicians, other practitioners, caregivers, and the community.
EXAM QUESTIONS AND ANSWERS
100% ACCURATE
revenue cycle - ANSWER-The _______________ is the process that begins when a
patient comes to a healthcare system for services and includes those activities that
have to occur in order for a provider of the care to bill at the end of the patient's service
encounter.
front end
middle
back end - ANSWER-The revenue management life cycle can be bro-ken down into
three phases?
front end - ANSWER-The _______________ of the revenue cycle includes patient
access functions such as scheduling the patient for services, registration of the patient,
prior or pre-authorization for services, insurance verification, service estimates, and
financial counseling.
Phase 1 of Rev Cycle Management (Front end) - ANSWER-During this phase,
healthcare organizations need to ascertain the source of payment for the service, follow
requirements specified by the payer, accurately collect the patient's demographic
information, and ensure a positive patient experience.
middle process - ANSWER-The ______________ of the revenue cycle includes case
management, capture of charges for the services rendered, and coding for those
services based on clinical documentation.
Phase 2 of Rev Cycle Management (Middle) - ANSWER-The key objectives in this
phase are to manage clinical practice according to accepted medical guidelines, identify
reimbursable services and ensure that documentation supports those services, and
ensure accurate and complete coding of the documented services.
back end - ANSWER-The ________________ of the revenue cycle is the business
office or patient financial service process and includes claims processing and payment
posting, fol-low-up, customer service, collections of unpaid bills, and denial
management.
Phase 3 of Rev Cycle Management (Back end) - ANSWER-In this phase, organizations
focus on releasing claims to the payers as quickly as possible after service is rendered
and generating accurate and complete claims resulting in reimbursement of the amount
expected by the payer.
, Front end process - ANSWER-Payor negotiation and renegotiation; patient access,
including scheduling, pre-authorization, insurance verification, point-of-service
collection, and financial counseling are all examples of which process of the Rev Cycle?
Middle process - ANSWER-Charge capture, case management, clinical documentation,
and coding are all examples of which process of the Rev Cycle?
Back end process - ANSWER-Claims processing and payment posting, follow-up,
customer service, collections, and denial management are all examples of which
process of the Rev Cycle?
scheduling and Registration - ANSWER-Staff responsible for _________________ and
____________________ functions requires a significant amount of knowledge
regarding the medical services provided, insurance carrier requirements, provider
preferences, and operational hours of services to be rendered.
Resources to support specific requirements include?
preregistration
insurance eligibility
benefit verification
payer authorizations
pre-service collections - ANSWER-The Pre Encounter Centers handle?
management of contracts - ANSWER-The ____________________ is an integral part
of the revenue cycle.
allowable costs
chargeable services
supplies provided by a hospital or physician - ANSWER-Healthcare facilities negotiate
contract terms with third-party insurers for payment of services rendered to patients.
This is where __________________, ____________________, and
________________________ that qualify as covered expenses are defined.
Contract management - ANSWER-__________________________ has its own life
cycle and contract managers need to have an understanding of competitor and local
market rates in order to negotiate reasonable reimbursement rates that cover the
health-care organization's expenses, while remaining competitive.
forecast | calculate | capture - ANSWER-Hospitals and healthcare systems need to
accurately ____________, _____________, and _____________ all net revenue
contractually owed to them from payers and patients.
case management - ANSWER-A collaborative practice model including patients,
nurses, social workers, physicians, other practitioners, caregivers, and the community.
