CHAPTER 2 - REVENUE CYCLE
MANAGEMENT WITH CORRECT
SOLUTIONS
Revenue Cycle Management - ANSWER-process facilities and providers use to ensure
financial viability.
revenue cycle auditing - ANSWER-assessment process that is conducted as a follow-up
to revenue cycle monitoring so that areas of poor performance can be identified and
corrected.
encounter form/superbill - ANSWER-Financial record source to record treated diagnosis
and procedures - PHYSICIAN OFFICE
Chargemaster - ANSWER-encounter form - HOSPITAL - computer generated list of
procedures, services, supplies, and their charges
Revenue code - ANSWER-a four-digit code pre-printed on a charge-master to show
location or type of service provided to hospital patient
Processing an insurance claim - ANSWER-used to report professional and technical
services
accept assignment - ANSWER-The provider agrees to accept what the insurance
company approves as payment in full for the claim.
Assignment of benefits - ANSWER-patient's written authorization giving the insurance
company the right to pay the physician directly for billed charges
Preauthorization - ANSWER-prior approval
guarantor - ANSWER-the person identified as responsible for payment of the bill
managed care alert - ANSWER-must obtain referral from PCP and maybe
preauthorizations
Participating provider (PAR) - ANSWER-contracts with a health insurance plan and
accepts whatever the plan pays for procedures or services performed
nonparticipating provider (NonPAR) (out of network provider) - ANSWER-Doesn't
contract with pts insurance plan and pts will have a higher out of pocket expense
MANAGEMENT WITH CORRECT
SOLUTIONS
Revenue Cycle Management - ANSWER-process facilities and providers use to ensure
financial viability.
revenue cycle auditing - ANSWER-assessment process that is conducted as a follow-up
to revenue cycle monitoring so that areas of poor performance can be identified and
corrected.
encounter form/superbill - ANSWER-Financial record source to record treated diagnosis
and procedures - PHYSICIAN OFFICE
Chargemaster - ANSWER-encounter form - HOSPITAL - computer generated list of
procedures, services, supplies, and their charges
Revenue code - ANSWER-a four-digit code pre-printed on a charge-master to show
location or type of service provided to hospital patient
Processing an insurance claim - ANSWER-used to report professional and technical
services
accept assignment - ANSWER-The provider agrees to accept what the insurance
company approves as payment in full for the claim.
Assignment of benefits - ANSWER-patient's written authorization giving the insurance
company the right to pay the physician directly for billed charges
Preauthorization - ANSWER-prior approval
guarantor - ANSWER-the person identified as responsible for payment of the bill
managed care alert - ANSWER-must obtain referral from PCP and maybe
preauthorizations
Participating provider (PAR) - ANSWER-contracts with a health insurance plan and
accepts whatever the plan pays for procedures or services performed
nonparticipating provider (NonPAR) (out of network provider) - ANSWER-Doesn't
contract with pts insurance plan and pts will have a higher out of pocket expense
