PRINCIPALS OF HEALTHCARE
REIMBURSEMENT AND REVENUE CYCLE
MANAGEMENT ACTUAL EXAM SOLVED
QUESTIONS COMPLETE PREPARATION
RESOURCE
●● Which is not typically an HIM department function?
Coding
Data Quality auditing
Coordination of bill error correction
Patient Registration
Answer: Patient Registration
●● What is a characteristic of information governance?
Aligns implementation outcomes to business priorities
Manages data transmission between departments
,Authorizes release of information
Conducts performance improvement projects
Answer: Aligns implementation outcomes to business priorities
●● The revenue cycle can be described as:
Registration, clinical services, coding and billing
Front-end process of patient intake, middle process of documentation,
charge capture, and coding: back end process of billing and collecitons
Patient intake, documentation of services, billing and collections
All of the above
,Answer: Front-end process of patient intake, middle process of
documentation, charge capture, and coding: back end process of billing
and collections
●● Why does utilization management need to understand DRGs?
U M needs to work with physicians to ensure that the medical necessity
of the stay is appropriately documented.
UM is responsible for monitoring a patient's expected length of stay
which is established by the working DRG.
The DRG for each case is established by utilization management so the
HIM coding professionals know what to look for when the patient is
discharged.
The physician needs to know the DRG so utilization management must
identify one by the time history and physical is done.
, Answer: UM is responsible for monitoring a patient's expected length of
stay which is established by the working DRG.
●● The average time to drop a final inpatient bill in your hospital is four
days, but bill old is there days. 50 percent of the claims dropping in
excess of four days are delayed due to a coding backlog. What do you do
recommend as a temporary solution?
Extend bill hold to five days so that fewer claims are late.
Hire an additional coder.
Bring in a consultant coder to reduce the backlog
Analyze the reason for the coding backlog.
Answer: Bring in a consultant coder to reduce the backlog
●● There has been a recent increase in errors regarding the posting of
the admitting diagnosis. Correction of this error falls to the coding staff.
REIMBURSEMENT AND REVENUE CYCLE
MANAGEMENT ACTUAL EXAM SOLVED
QUESTIONS COMPLETE PREPARATION
RESOURCE
●● Which is not typically an HIM department function?
Coding
Data Quality auditing
Coordination of bill error correction
Patient Registration
Answer: Patient Registration
●● What is a characteristic of information governance?
Aligns implementation outcomes to business priorities
Manages data transmission between departments
,Authorizes release of information
Conducts performance improvement projects
Answer: Aligns implementation outcomes to business priorities
●● The revenue cycle can be described as:
Registration, clinical services, coding and billing
Front-end process of patient intake, middle process of documentation,
charge capture, and coding: back end process of billing and collecitons
Patient intake, documentation of services, billing and collections
All of the above
,Answer: Front-end process of patient intake, middle process of
documentation, charge capture, and coding: back end process of billing
and collections
●● Why does utilization management need to understand DRGs?
U M needs to work with physicians to ensure that the medical necessity
of the stay is appropriately documented.
UM is responsible for monitoring a patient's expected length of stay
which is established by the working DRG.
The DRG for each case is established by utilization management so the
HIM coding professionals know what to look for when the patient is
discharged.
The physician needs to know the DRG so utilization management must
identify one by the time history and physical is done.
, Answer: UM is responsible for monitoring a patient's expected length of
stay which is established by the working DRG.
●● The average time to drop a final inpatient bill in your hospital is four
days, but bill old is there days. 50 percent of the claims dropping in
excess of four days are delayed due to a coding backlog. What do you do
recommend as a temporary solution?
Extend bill hold to five days so that fewer claims are late.
Hire an additional coder.
Bring in a consultant coder to reduce the backlog
Analyze the reason for the coding backlog.
Answer: Bring in a consultant coder to reduce the backlog
●● There has been a recent increase in errors regarding the posting of
the admitting diagnosis. Correction of this error falls to the coding staff.
