HFMA 2 Questions and Correct Solutions 2024

HFMA 2 Questions and Correct Solutions 2024 Describe the paper and electronic claims flow process. - Answer -1. Electronic Claim Submission= EDI claims forwarded to either directly or via EDI clearing house/ vendor. 2. Claims Verification= Clearinghouse specifications and insurance company requirements used to validate transmitted claims. 3. Rejected Claims = Claims not meeting requirements returned via clearinghouse error report. 4. Accepted claims= sent to insurance company for provider ID verification. 5. Providers are responsible for verification of EDI claims receipts. 6.Accepted /rejected claims must be reviewed and validated against transmittal records daily. Describe the purpose of the 835 and 837 EDI transactions. - Answer -EDI transactions include the 837 and 835 transactions. The 837 EDI transaction is used to submit healthcare claim billing information, encounter information, or both. It can be sent from providers of healthcare services to payers, either directly or via intermediary billers and claims clearinghouses. It can also be used to transmit healthcare claims and billing payment information between payers with different payment responsibilities where coordination of benefits is required or between payers and regulatory agencies to monitor the rendering, billing, and/or payment of healthcare services within a specific healthcare/insurance industry segment. The 835 EDI transaction can be used to make a payment, send an Explanation of Benefits (EOB) remittance advice, or make a payment and send an EOB remittance advice only from a health insurer to a healthcare provider either directly or via a financial institution.Who are the typical revenue cycle team members? - Answer -Typical revenue cycle team members include the following: 1) Access management 2) Case management 3) Managed care contracting coordinator 4) Patient care representatives 5) CDM manager 6) Revenue integrity leader 7) Ancillary services 8) ED 9) Health information management 10) Patient financial services 11) Decision support 12) Finance and accounting (CFO) 13) Compliance 14) Information technol