REVENUE CYCLE TEST PAPER 2026 COMPLETE
QUESTIONS AND SOLUTIONS GRADED A+
◉ Multidisciplinary Model Answer: = is where the 21st century
approach to RCM in health care facilities is based on.
= this dynamic management style promotes collaboration among
various clinical departments by creating an RCM team composed of
representatives from all revenue cycle areas.
◉ True or False:
A key to good revenue cycle management is having all areas and
units understand the entire cycle; not just the pieces or parts for
which a particular unit is responsible. And good communication and
team work is required. Answer: True
◉ Revenue Cycle from a Patient Perspective Answer: 1st = Patient is
scheduled for treatment
2nd = Patient is admitted, pays cost sharing portion
3rd = Treatment provided, supplies used and resources consumed
4th = Patient is discharged
5th = Patient receives explanation of benefits (EOB)
6th = Patient receives bill from facility and/or physician
,◉ Revenue Cycle from a Facility or Provider Perspective Answer: 1st
= Patient is scheduled and preauthorized
2nd = Patient is admitted, demographic and payer information
collected
3rd = Services are rendered to patient, charges are captured via
CDM.
= this is where the CDM charge entry happens
= this is where the HARD coding happens
4th = Medical records are reviewed and coded
= this is where SOFT coding happens
5th = Claim is produces, audited (scrubbed), and corrected
6th = Claim is transmitted to Payer
7th = Accounts are managed until payments are received
8th = Payments and remittance advice are received from payer
9th = Claims corrected and financial adjustments made as warranted
10th = Outstanding cost sharing payments are collected from patient
◉ Components of the revenue cycle: Answer: 1) Pre-Claims
Submission
2) Claims Processing
3) Accounts Receivable
4) Claims Reconciliation and Collections
,◉ 1) Pre-Claims Submission Activities Answer: = comprise tasks and
functions from the patient registration and case management areas.
Specifically, this portion of the revenue cycle is responsible for
collecting the patient's and responsible parties' information
completely and accurately for:
1. Determining the appropriate financial class
2. For educating the patient about his or her ultimate fiscal
responsibility for services rendered
3. For collecting waivers when appropriate
4. For verifying data prior to procedures or services being
performed and submitted for payment.
= Example: Admitting representative is responsible for collecting the
patient demographic data, such as age, date of birth, address, and
the individual's Medicare beneficiary identifier (MBI).
◉ Pre-claims Submission Objectives: Answer: > Collect the patients
and/or responsible party's information completely and accurately
> Determine the appropriate financial class or account type
> Educate the patient as to their ultimate financial responsibility for
services rendered
> verify all data collected prior to rendering services or submitting
claims
◉ 2) Claims Processing activities Answer: = include the:
1. Capture of all billable services,
, 2. Claim generation, and
3. Claim corrections.
◉ Charge Capture Answer: = is a vital component of the revenue
cycle. All clinical areas that provide services to a patient must report
charges for the services that they have performed.
◉ Claims Processing Activities Objectives: Answer: > Capture of all
billable services
> Claim generation
> Claims correction
◉ Main Processes included in the Claims Processing include:
Answer: 1. order entry
2. coding and charge generation with the charge description master
(CDM)
3. coding by health information management (HIM)
4. auditing and review
5. claims submission
◉ 1. order entry Answer: = involve the use of electronic order entry
systems and paper-based process as well
= help capture the charge at the point of service delivery
QUESTIONS AND SOLUTIONS GRADED A+
◉ Multidisciplinary Model Answer: = is where the 21st century
approach to RCM in health care facilities is based on.
= this dynamic management style promotes collaboration among
various clinical departments by creating an RCM team composed of
representatives from all revenue cycle areas.
◉ True or False:
A key to good revenue cycle management is having all areas and
units understand the entire cycle; not just the pieces or parts for
which a particular unit is responsible. And good communication and
team work is required. Answer: True
◉ Revenue Cycle from a Patient Perspective Answer: 1st = Patient is
scheduled for treatment
2nd = Patient is admitted, pays cost sharing portion
3rd = Treatment provided, supplies used and resources consumed
4th = Patient is discharged
5th = Patient receives explanation of benefits (EOB)
6th = Patient receives bill from facility and/or physician
,◉ Revenue Cycle from a Facility or Provider Perspective Answer: 1st
= Patient is scheduled and preauthorized
2nd = Patient is admitted, demographic and payer information
collected
3rd = Services are rendered to patient, charges are captured via
CDM.
= this is where the CDM charge entry happens
= this is where the HARD coding happens
4th = Medical records are reviewed and coded
= this is where SOFT coding happens
5th = Claim is produces, audited (scrubbed), and corrected
6th = Claim is transmitted to Payer
7th = Accounts are managed until payments are received
8th = Payments and remittance advice are received from payer
9th = Claims corrected and financial adjustments made as warranted
10th = Outstanding cost sharing payments are collected from patient
◉ Components of the revenue cycle: Answer: 1) Pre-Claims
Submission
2) Claims Processing
3) Accounts Receivable
4) Claims Reconciliation and Collections
,◉ 1) Pre-Claims Submission Activities Answer: = comprise tasks and
functions from the patient registration and case management areas.
Specifically, this portion of the revenue cycle is responsible for
collecting the patient's and responsible parties' information
completely and accurately for:
1. Determining the appropriate financial class
2. For educating the patient about his or her ultimate fiscal
responsibility for services rendered
3. For collecting waivers when appropriate
4. For verifying data prior to procedures or services being
performed and submitted for payment.
= Example: Admitting representative is responsible for collecting the
patient demographic data, such as age, date of birth, address, and
the individual's Medicare beneficiary identifier (MBI).
◉ Pre-claims Submission Objectives: Answer: > Collect the patients
and/or responsible party's information completely and accurately
> Determine the appropriate financial class or account type
> Educate the patient as to their ultimate financial responsibility for
services rendered
> verify all data collected prior to rendering services or submitting
claims
◉ 2) Claims Processing activities Answer: = include the:
1. Capture of all billable services,
, 2. Claim generation, and
3. Claim corrections.
◉ Charge Capture Answer: = is a vital component of the revenue
cycle. All clinical areas that provide services to a patient must report
charges for the services that they have performed.
◉ Claims Processing Activities Objectives: Answer: > Capture of all
billable services
> Claim generation
> Claims correction
◉ Main Processes included in the Claims Processing include:
Answer: 1. order entry
2. coding and charge generation with the charge description master
(CDM)
3. coding by health information management (HIM)
4. auditing and review
5. claims submission
◉ 1. order entry Answer: = involve the use of electronic order entry
systems and paper-based process as well
= help capture the charge at the point of service delivery
