The Revenue Cycle & Revenue Cycle Management Exam Questions and Answers Already Passed

The Revenue Cycle & Revenue Cycle Management Exam Questions and Answers Already Passed Definition of Revenue Cycle Management (RCM) - Answers is the supervision of all administrative and clinical functions that contribute to the capture, management and collection of patient service revenue. Pre-Claims Submission Activities - Answers PreAdmit/Scheduling/Admissions/Registration/Patient Access Service/Front End Processes Case Management/Utilization Review - Answers a.Inpatient Medical Necessity (Admission Criteria) b.Determination of Appropriate Level of Care c.Procedural Pre-Certification d.Medical Necessity for Ambulatory Diagnostic Testing Charge Capture - Answers assure that billable services are charged Electronic - Answers capture charge at point of service - order entry Manual - Answers charge tickets processed daily Coding Patient Records - Answers Best Practice - 98% accuracy Hard Coded - Answers Charge Master - lab, xray, medications, supplies, etc. Manual Coding - Answers HIM Department - all diagnoses and significant procedures Scrubber - Answers internal auditing - prior to claims submission and Payer Auditing of Submitted Claim Outpatient Code Editor (OCE) - Answers Edits Data/Claims Disposition Rejected Claim/Line Item - Answers Can be Corrected and Resubmitted Denied Claim/Line Item - Answers Must be Appealed Suspended - Answers usually awaiting additional information Assigns OPPS Ambulatory Payment Classification (APC) - Answers 1. CPT/HCPCS status indicators 2. APC 3. Payment indicator a. Discounts