CHAPTER 10: REVENUE CYCLE
MANAGEMENT QUESTIONS AND
ANSWERS 100% CORRECT
Clinical Documentation Improvement (CDI) - ANSWER-A program to ensure that the
health record accurately reflects the condition of the patient. The American Health
Information Management Association (AHIMA) defines the program as that which is
used to initiate concurrent and, as appropriated, retrospective reviews of inpatient
health records for conflicting, incomplete, or nonspecific provider documentation.
Point-of-service collections - ANSWER-The collection of the portion of the bill that is
likely the responsibility of the patient prior to the provision of services.
Charity care - ANSWER-When a patient receives care and does not have the means by
which to pay for the care delivered. The patient, or guarantor, will need to fill out
financial paperwork to support being deemed as this type of care.
Charge Description Master (CDM) - ANSWER-An electronic file that represents a
master list of all services, supplies, devices, and medications that are charged for
inpatient or outpatient services.
Revenue cycle management (RCM) - ANSWER-A complex process that involves
balancing people, processes, technology, and the environment in which the process
takes place.
Quality measures - ANSWER-The four measures: process, outcome, patient
experience, and structure.
Contract management - ANSWER-An important part of the episode-of-care payment
method that requires the providers of care, along with the plans, to be as precise as
possible in projecting expenditures in order to negotiate a contract that will cover the
costs involved in treating the members of the plan.
Case Mix Index (CMI) - ANSWER-An index that is measurable and analyzable and
allows the organization to compare the cost of providing services to its DRG mix and
compare it to other like or similar hospitals. It is calculated by summing up the Medicare
DRG's weight for the number of patients in the DRG. Then the sum of the weights is
divided by the total number of discharges.
MANAGEMENT QUESTIONS AND
ANSWERS 100% CORRECT
Clinical Documentation Improvement (CDI) - ANSWER-A program to ensure that the
health record accurately reflects the condition of the patient. The American Health
Information Management Association (AHIMA) defines the program as that which is
used to initiate concurrent and, as appropriated, retrospective reviews of inpatient
health records for conflicting, incomplete, or nonspecific provider documentation.
Point-of-service collections - ANSWER-The collection of the portion of the bill that is
likely the responsibility of the patient prior to the provision of services.
Charity care - ANSWER-When a patient receives care and does not have the means by
which to pay for the care delivered. The patient, or guarantor, will need to fill out
financial paperwork to support being deemed as this type of care.
Charge Description Master (CDM) - ANSWER-An electronic file that represents a
master list of all services, supplies, devices, and medications that are charged for
inpatient or outpatient services.
Revenue cycle management (RCM) - ANSWER-A complex process that involves
balancing people, processes, technology, and the environment in which the process
takes place.
Quality measures - ANSWER-The four measures: process, outcome, patient
experience, and structure.
Contract management - ANSWER-An important part of the episode-of-care payment
method that requires the providers of care, along with the plans, to be as precise as
possible in projecting expenditures in order to negotiate a contract that will cover the
costs involved in treating the members of the plan.
Case Mix Index (CMI) - ANSWER-An index that is measurable and analyzable and
allows the organization to compare the cost of providing services to its DRG mix and
compare it to other like or similar hospitals. It is calculated by summing up the Medicare
DRG's weight for the number of patients in the DRG. Then the sum of the weights is
divided by the total number of discharges.
