CHAPTER 4: REVENUE CYCLE
MANAGEMENT QUESTIONS WITH
SOLUTIONS
The intent of mandating the Health Insurance Portability and Accountability Act (HIPAA) national
standards for electronic transactions was to ✔ans improve the efficiency and effectiveness of the health
care system
Electronic claims are ✔ans checked for accuracy by billing software programs or a health care
clearinghouse
Which CPT modifier will require supporting documentation for payment? ✔ans -22 (unusual procedure
services)
Patients can be billed for ✔ans noncovered procedures or exclusions
If the claim was denied because the service is not covered by the payer, the claim is ✔ans not paid by
the third-party payer
The person in whose name the insurance policy is issued is the ✔ans policyholder / subscriber / insured
The individual who is primarily responsible for paying health care fees or payment of balance ✔ans
Guarantor
The cycle of an insurance claim is initiated when the ✔ans health insurance specialist completes the
CMS-1500 claim
Which is considered the financial source document? ✔ans Superbill or encounter form
, Another name for the patient account record is the patient ✔ans ledger
A chronological summary of all transactions posted to individual patient accounts on a specific day is
recorded on a(n) ✔ans day sheet
What special handling is required if a patient requests a copy of the remittance advice (remit) that
contains information about multiple patients? ✔ans Identifying information about all patients except
the requesting patient is removed
Which federal law protects consumers against harassing or threatening phone calls from collectors?
✔ans Fair Debt Collection Practices Act
To determine whether a claim is delinquent, review the status of all outstanding claims from each payer
and payments due from patients by generating an accounts receivable ________________ report. ✔ans
aging
The provision in group health insurance policies that specifies in what sequence coverage will be
provided when more than one policy covers the claim is ✔ans coordination of benefits
A clearinghouse that coordinates with other entities to provide additional services during the processing
of claims is a ✔ans value-added network
To determine if a patient is receiving concurrent care for the same condition by more than one provider,
the payer will check the claim against the ✔ans common data file
Diagnosis and procedure codes that are entered incorrectly during billing and claims processing result in
________________ by the third-party payer. ✔ans denied and rejected claims
CMS-1500 or UB-04 claims that are resubmitted to third-party payers usually result in payment delays
and claims denials. The resubmission of claims is a result of ✔ans entering late or lost charges or making
corrections to previously processed CMS-1500 or UB-04 claims
MANAGEMENT QUESTIONS WITH
SOLUTIONS
The intent of mandating the Health Insurance Portability and Accountability Act (HIPAA) national
standards for electronic transactions was to ✔ans improve the efficiency and effectiveness of the health
care system
Electronic claims are ✔ans checked for accuracy by billing software programs or a health care
clearinghouse
Which CPT modifier will require supporting documentation for payment? ✔ans -22 (unusual procedure
services)
Patients can be billed for ✔ans noncovered procedures or exclusions
If the claim was denied because the service is not covered by the payer, the claim is ✔ans not paid by
the third-party payer
The person in whose name the insurance policy is issued is the ✔ans policyholder / subscriber / insured
The individual who is primarily responsible for paying health care fees or payment of balance ✔ans
Guarantor
The cycle of an insurance claim is initiated when the ✔ans health insurance specialist completes the
CMS-1500 claim
Which is considered the financial source document? ✔ans Superbill or encounter form
, Another name for the patient account record is the patient ✔ans ledger
A chronological summary of all transactions posted to individual patient accounts on a specific day is
recorded on a(n) ✔ans day sheet
What special handling is required if a patient requests a copy of the remittance advice (remit) that
contains information about multiple patients? ✔ans Identifying information about all patients except
the requesting patient is removed
Which federal law protects consumers against harassing or threatening phone calls from collectors?
✔ans Fair Debt Collection Practices Act
To determine whether a claim is delinquent, review the status of all outstanding claims from each payer
and payments due from patients by generating an accounts receivable ________________ report. ✔ans
aging
The provision in group health insurance policies that specifies in what sequence coverage will be
provided when more than one policy covers the claim is ✔ans coordination of benefits
A clearinghouse that coordinates with other entities to provide additional services during the processing
of claims is a ✔ans value-added network
To determine if a patient is receiving concurrent care for the same condition by more than one provider,
the payer will check the claim against the ✔ans common data file
Diagnosis and procedure codes that are entered incorrectly during billing and claims processing result in
________________ by the third-party payer. ✔ans denied and rejected claims
CMS-1500 or UB-04 claims that are resubmitted to third-party payers usually result in payment delays
and claims denials. The resubmission of claims is a result of ✔ans entering late or lost charges or making
corrections to previously processed CMS-1500 or UB-04 claims
