Revenue Cycle Management UPDATED Exam Questions and CORRECT Answers

Revenue Cycle Management UPDATED
Exam Questions and CORRECT Answers
Revenue Cycle Management/Accounts Receivable Management - Correct Answer- The
process by which health care facilities and providers ensure their financial viability by
increasing revenue, improving cash flow, and enhancing the patient's experience.


Claims Rejections - Correct Answer- Unpaid claims that fail to meet certain data.


Claims Denials - Correct Answer- Unpaid claims that contain beneficiary identification
errors, coding errors, diagnoses that do not support medical necessity of procedures/services
performed, duplicate claims, global days of surgery E/M coverage issues, national correct
coding initiative edits and outpatient code editor issues, and other patient coverage issues.


Quarterly Provider Updates (QPUs) - Correct Answer- Regulations and major policies
implemented or cancelled, new and revised manual instructions, regulations that establish or
modify the way CMS administers its programs.


Utilization Management/Utilization Review - Correct Answer- Method of controlling
healthcare cost and quality of care by reviewing the appropriateness and necessity of care
provided to patients prior to the administration of care or after care has been provided.


Prospective Review - Correct Answer- Prior to the administration of care.


Retrospective Review - Correct Answer- After care has been provided.


Preadmission Certification (PAC)/Preadmission Review - Correct Answer- Review for
medical necessity of inpatient care prior to the patient's admission.


Preauthorization/Precertification/Prior Approval/ Prior Authorization - Correct Answer-
Review by health plans to grant prior approval for reimbursement of health care services.


Concurrent Review - Correct Answer- Review for medical necessity of tests and procedures
ordered during an inpatient hospitalization.

, Discharge Planning - Correct Answer- Arranging appropriate healthcare services for the
discharged patient.


Revenue Cycle Monitoring - Correct Answer- Assessing the revenue cycle to ensure financial
viability and stability using metrics.


Metrics - Correct Answer- Standards of measurement


Revenue Cycle Auditing - Correct Answer- An assessment process that is conducted as a
follow-up to revenue cycle monitoring so that areas of poor performance can be identified
and corrected.


Resource Allocation - Correct Answer- Distribution of financial resources among competing
groups.


Resource Allocation Monitoring - Correct Answer- Uses data analytics to measure whether a
health care provider or organization achieves operational goals and objectives within the
confines of the distribution of financial resources, such as appropriately expending budgeted
amounts as well as conserving resources and protecting assets while providing quality patient
care.


Data Analytics - Correct Answer- Tools and systems that are used to analyze clinical and
financial data, conduct research, and evaluate the effectiveness of disease treatments.


Data Warehouses - Correct Answer- Databases that use reporting interfaces to consolidate
multiple databases, allowing reports to be generated from a single request.


Data Mining - Correct Answer- Extracting and analyzing data to identify patterns, whether
predictable or unpredictable.


Encounter Form/Superbill - Correct Answer- Financial record source document used by
health care providers and other personnel to record treated diagnoses and services rendered to
the patient during the current encounter.


Chargemaster/Charge Description Master (CDM) - Correct Answer- Document that contains
a computer-generated list of procedures, services, and supplies with charges for each.