Revenue Management Exam 2023 Questions and Answers
Complete
Patients who are assigned the same DRG have all of the following comparable
criteria, except:
A.Diagnosis code
B.Healthcare protocol
C.Length of stay
D.Utilization management
C.Length of stay
Joe Patient was admitted to Community Hospital. two days later, he was
transferred to big Medical Center for further evaluation and treatment. He was
discharged to home after three days. Community Hospital will receive from
Medicare:
A.The full DRG amount, and Big Medical Center will receive a per diem rate for the
three-day stay
B.A per diem rate for the two-day stay, and Big Medical Center will receive the full
DRG payment
C.The full DRG amount, and Big Medical Center will bill Community Hospital a per
diem rate for the three-day stay
D.No payment; Community Hospital must bill Big Medical Center a per diem rate
for the two-day stay
B.A per diem rate for the two-day stay, and Big Medical Center will receive the full DRG
payment
The accounts not selected for billing report is used to track accounts that are:
A.Awaiting payment in accounts receivable
B.Paid at different rates
C.In bill hold or in error and awaiting billing
D.Pulled for quality review
C.In bill hold or in error and awaiting billing
For a provider who has a fee-for-service payment arrangement, what action
should be taken after the respective diagnosis and procedure codes have been
assigned?
A.Percent discount for each procedure service
B.Fee for bundled services
C.Send fee schedule to third party payer
D.Assign a fee to each procedure code
D.Assign a fee to each procedure code
Which of the following is an example of a common form of healthcare fraud and
abuse?
A.Billing for services not furnished to patients
B.Clinical documentation improvement
C.Refiling claims after denials
D.Use of a claim scrubber prior to submitting bills
A.Billing for services not furnished to patients
, In most instances, the "owner" of the charge description master (CDM) in a
healthcare facility is the:
A.HIM Department
B.Information technology department
C.Finance department
D.Patient accounts department
C.Finance department
Using the charge description master (CDM) to automatically link a service to the
appropriate CPT/HCPCS code is referred to as:
A.Concurrent coding
B.Hard coding
C.Official coding
D.Upcoding
B.Hard coding
If the provider is a Medicare participating provider, the balance between the
amount charged for a service and the amount Medicare allows is:
A.Adjusted off from the patient account
B.Charged to the patient
C.Billed to the secondary insurance
D.The health insurance claim should be rebilled for higher reimbursement
A.Adjusted off from the patient account
A Medicare patient had two physician office visits, underwent hospital radiology
examinations and clinical laboratory tests, and received take-home surgical
dressings. Which of the following could be reimbursed under the outpatient
prospective payment system?
A.Clinical laboratory tests
B.Physician office visits
C.Radiology examinations
D.Take-home surgical dressings
C.Radiology examinations
Sandra currently has Medicare for primary insurance and Medicaid for secondary
insurance. The hospital billed $2,500 for a colonoscopy. Medicare allowed $950
and paid $760. The Medicaid allowed amount for the colonoscopy is $750. What
amount should Medicaid reimburse as the secondary payer?
A.$19
B.$150
C.$190
D.Nothing
D.Nothing
Which of the following is the definition of revenue cycle management?
A.The regularly repeating set of events that produce revenue or income
B.The method by which patients are grouped together based on a set of
characteristics
C.the systematic ccomparison of the products, services, and outcomes of one
organization with those of a similar organization
Complete
Patients who are assigned the same DRG have all of the following comparable
criteria, except:
A.Diagnosis code
B.Healthcare protocol
C.Length of stay
D.Utilization management
C.Length of stay
Joe Patient was admitted to Community Hospital. two days later, he was
transferred to big Medical Center for further evaluation and treatment. He was
discharged to home after three days. Community Hospital will receive from
Medicare:
A.The full DRG amount, and Big Medical Center will receive a per diem rate for the
three-day stay
B.A per diem rate for the two-day stay, and Big Medical Center will receive the full
DRG payment
C.The full DRG amount, and Big Medical Center will bill Community Hospital a per
diem rate for the three-day stay
D.No payment; Community Hospital must bill Big Medical Center a per diem rate
for the two-day stay
B.A per diem rate for the two-day stay, and Big Medical Center will receive the full DRG
payment
The accounts not selected for billing report is used to track accounts that are:
A.Awaiting payment in accounts receivable
B.Paid at different rates
C.In bill hold or in error and awaiting billing
D.Pulled for quality review
C.In bill hold or in error and awaiting billing
For a provider who has a fee-for-service payment arrangement, what action
should be taken after the respective diagnosis and procedure codes have been
assigned?
A.Percent discount for each procedure service
B.Fee for bundled services
C.Send fee schedule to third party payer
D.Assign a fee to each procedure code
D.Assign a fee to each procedure code
Which of the following is an example of a common form of healthcare fraud and
abuse?
A.Billing for services not furnished to patients
B.Clinical documentation improvement
C.Refiling claims after denials
D.Use of a claim scrubber prior to submitting bills
A.Billing for services not furnished to patients
, In most instances, the "owner" of the charge description master (CDM) in a
healthcare facility is the:
A.HIM Department
B.Information technology department
C.Finance department
D.Patient accounts department
C.Finance department
Using the charge description master (CDM) to automatically link a service to the
appropriate CPT/HCPCS code is referred to as:
A.Concurrent coding
B.Hard coding
C.Official coding
D.Upcoding
B.Hard coding
If the provider is a Medicare participating provider, the balance between the
amount charged for a service and the amount Medicare allows is:
A.Adjusted off from the patient account
B.Charged to the patient
C.Billed to the secondary insurance
D.The health insurance claim should be rebilled for higher reimbursement
A.Adjusted off from the patient account
A Medicare patient had two physician office visits, underwent hospital radiology
examinations and clinical laboratory tests, and received take-home surgical
dressings. Which of the following could be reimbursed under the outpatient
prospective payment system?
A.Clinical laboratory tests
B.Physician office visits
C.Radiology examinations
D.Take-home surgical dressings
C.Radiology examinations
Sandra currently has Medicare for primary insurance and Medicaid for secondary
insurance. The hospital billed $2,500 for a colonoscopy. Medicare allowed $950
and paid $760. The Medicaid allowed amount for the colonoscopy is $750. What
amount should Medicaid reimburse as the secondary payer?
A.$19
B.$150
C.$190
D.Nothing
D.Nothing
Which of the following is the definition of revenue cycle management?
A.The regularly repeating set of events that produce revenue or income
B.The method by which patients are grouped together based on a set of
characteristics
C.the systematic ccomparison of the products, services, and outcomes of one
organization with those of a similar organization
