AHIMA Revenue Cycle Management Best Practices – Quiz with Complete Solutions

AHIMA Revenue Cycle Management Best Practices – Quiz with Complete Solutions In the revenue cycle, what is the role of Administration? - Strategic goals - Operational efficiency and effectiveness In the revenue cycle, what is the role of Finance? Cash flow In the revenue cycle, what is the role of Managed Care/ Payer Services? - Contract management - Material breach issues affecting reimbursement (claims projects) In the revenue cycle, what is the role of Patient Access? - Data Integrity and quality assurance - Demographic and financial data - Insurance verification - Precertification In the revenue cycle, what is the role of Clinical/Ancillary services (incl physicians)? - Clear, concise documentation of services - Documentation and recordings of charges In the revenue cycle, what is the role of Health Information Management? - Coding - Abstracting - Data validation and quality assurance In the revenue cycle, what is the role of Patient Accounting? - Compilation of charges - Billing - Collections What are the front-end functions of the Patient Intake team? - Recording reason for visit - Verifying and recording patient identifying data - Verifying and recording patient financial data (insurance and guarantor) - Obtaining precertification/authorization - Identifying patients who will need financial assistance to cover the cost of care - Assigning patient tracking numbers, including MR number - Assigning clinical-service tracking codes if applicable Case Management Department Also called Utilization Management dept. Ensures that all managed care patients meet the payer's specific utilization management medical-necessity standards. What are the key routine activities of the revenue cycle team? - Review key performance indicators (KPIs) - Conduct inquiries into processes that are not meeting benchmarks - Monitor denials and clean-claim rates - Initiate performance improvement activities as needed - Oversee development and implementation of revenue cycle-related processes What are key strategic activities of the revenue cycle team? - Set benchmarks for KPIs - Identify trends in financial data and make recommendations to administration - Anticipate the impact of changing regulations, such as implementation of ICD-10-CM/PCS, on the revenue cycle Case-mix index (CMI) = = total weight / total cases Roles of Information Governance - Establishes policy-level rules - Defines investment priorities - Institutes accountability - Aligns implementation outcomes to business priorities - Measures results Benchmarking measures loosely fall into one of three categories: - Optimizing revenue - Timely billing - Increasing collections