AHIMA Revenue Cycle Management Best Practices Questions With Complete Solutions (Verified And Updated)

AHIMA Revenue Cycle Management Best Practices Questions With Complete Solutions (Verified And Updated) In the revenue cycle, what is the role of Administration? - answer- Strategic goals - Operational efficiency and effectiveness In the revenue cycle, what is the role of Finance? - answerCash flow In the revenue cycle, what is the role of Managed Care/ Payer Services? - answer- Contract management - Material breach issues affecting reimbursement (claims projects) In the revenue cycle, what is the role of Patient Access? - answer- 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)? - answer- Clear, concise documentation of services - Documentation and recordings of charges In the revenue cycle, what is the role of Health Information Management? - answer- Coding - Abstracting - Data validation and quality assurance In the revenue cycle, what is the role of Patient Accounting? - answer- Compilation of charges - Billing - Collections What are the front-end functions of the Patient Intake team? - answer- 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 - answerAlso 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? - answer- 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? - answer- 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) = - answer= total weight / total cases Roles of Information Governance - answer- 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: - answer- Optimizing revenue - Timely billing - Increasing collections 4 drivers of revenue - answer- market size - market share - product mix - quality 3 ways to control cost - answer- Daily management of costs - Process-based cost savings - Strategic cost management PDCA - answerPlan-Do-Check-Act Performance improvement methodology that serves to improve outcomes through analysis and amendment of processes. Six Sigma - answerA variation on PDCA - Uses statistical analysis to assess problems, both to determine whether there is a defect in a process and to determine whether an improvement has been successful. Most successfully applied to healthcare when it is used in conjunction with Lean methodologies Lean Methodologies - answerTarget waste and inefficiencies in a process in order to streamline the process itself. 4 levels of Visual controls - answer- Visual indicator - Visual signal - Visual control - Visual guarantee 3 Cost Clarifications - answerTraceability, Variability, Controllability 2 Categories of Traceability - answerDirect costs and indirect costs 3 types of cost variability - answerVariable, fixed, mixed 4 models (methods) for the distribution of costs - answer1) Step-down method 2) Direct method 3) Double-distribution method 4) Simultaneous-equations method