NHA Certified Billing & Coding Specialist Study Guide
3.0: The Revenue Cycle and Regulatory Compliance
CLOSE || 100% SOLVED!!
account receivable correct answers The amount owed to a provider for health care services
rendered.
if the billing department notices errors from the other departments that affect the ability to
create clean claims, they should? correct answers Notify the billing manager so that an action
can be implemented to correct the workflow needed to generate clean claims.
When claims are denied the best practice is too? correct answers is to perform an analysis to
determine where the errors are occurring. An action plan can include separating the errors by
department
billing and coding errors are? correct answers Code linkage errors and Preauthorization not
obtained
Billing and coding errors not only cause delays in reimbursements but also? correct answers
Incur additional time and resources for claim correction, resubmission, and resolution.
The insurance plan cannot process a claim for reimbursement if the patient's date of birth
cannot be identified with? correct answers the policy number
delay claims prevent payment to the? correct answers provider, which can affect accounts
payable.
revenue cycle management correct answers Process that health care providers use to manage
financial viability by increasing, revenue, improving cash flow, from registration to final
payment.
The primary stakeholders in health care are? correct answers Providers, patients, and payers.
The goal for revenue cycle management is too? correct answers collect full payment for
services rendered in a timely and efficient manner.
Coinsurance correct answers Predetermined percentage the patient is responsible to pay for
covered services once the annual deductible has been met.
Deductible correct answers Annual amount you must pay before you begin receiving any
benefits from your insurance company
Utilization Management Review correct answers A method of controlling health care costs by
reviewing services to be provided to members of a plan to determine the appropriateness and
medical necessity of the care prior to the delivery of the care.
Preauthorization correct answers The process by which the provider contacts the insurance
carrier to see if the proposed procedure is covered by a specific patient's insurance policy
3.0: The Revenue Cycle and Regulatory Compliance
CLOSE || 100% SOLVED!!
account receivable correct answers The amount owed to a provider for health care services
rendered.
if the billing department notices errors from the other departments that affect the ability to
create clean claims, they should? correct answers Notify the billing manager so that an action
can be implemented to correct the workflow needed to generate clean claims.
When claims are denied the best practice is too? correct answers is to perform an analysis to
determine where the errors are occurring. An action plan can include separating the errors by
department
billing and coding errors are? correct answers Code linkage errors and Preauthorization not
obtained
Billing and coding errors not only cause delays in reimbursements but also? correct answers
Incur additional time and resources for claim correction, resubmission, and resolution.
The insurance plan cannot process a claim for reimbursement if the patient's date of birth
cannot be identified with? correct answers the policy number
delay claims prevent payment to the? correct answers provider, which can affect accounts
payable.
revenue cycle management correct answers Process that health care providers use to manage
financial viability by increasing, revenue, improving cash flow, from registration to final
payment.
The primary stakeholders in health care are? correct answers Providers, patients, and payers.
The goal for revenue cycle management is too? correct answers collect full payment for
services rendered in a timely and efficient manner.
Coinsurance correct answers Predetermined percentage the patient is responsible to pay for
covered services once the annual deductible has been met.
Deductible correct answers Annual amount you must pay before you begin receiving any
benefits from your insurance company
Utilization Management Review correct answers A method of controlling health care costs by
reviewing services to be provided to members of a plan to determine the appropriateness and
medical necessity of the care prior to the delivery of the care.
Preauthorization correct answers The process by which the provider contacts the insurance
carrier to see if the proposed procedure is covered by a specific patient's insurance policy
