1|Page
REVENUE CYCLE MANAGEMENT Exam; Actual
Exam Questions With Correct Verified
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.
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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.
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Concurrent Review - Correct-answer-Review for medical necessity of tests and
procedures ordered during an inpatient hospitalization.
Electronic Flat File Format/Electronic Media Claim - Correct-answer-A series of
fixed-length records submitted to payers as a bill for health care services.
ANSI ASC X12N - Correct-answer-An electronic format standard that uses a
variable length file format to process transactions for institutional, professional,
dental, and drug claims.
Electronic Data Interchange (EDI) - Correct-answer-the computer-to-computer
transfer of data between providers and third-party payers in a data format agreed
upon by sending and receiving parties.
Covered Entities - Correct-answer-Process electronic claims and include all
private-sector health plans, managed care organizations, ERISA-covered health
benefit plans, government health plans, all health care clearinghouses, and all
health care providers that choose to submit or receive these transactions
electronically.
REVENUE CYCLE MANAGEMENT Exam; Actual
Exam Questions With Correct Verified
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.
,2|Page
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.
, 3|Page
Concurrent Review - Correct-answer-Review for medical necessity of tests and
procedures ordered during an inpatient hospitalization.
Electronic Flat File Format/Electronic Media Claim - Correct-answer-A series of
fixed-length records submitted to payers as a bill for health care services.
ANSI ASC X12N - Correct-answer-An electronic format standard that uses a
variable length file format to process transactions for institutional, professional,
dental, and drug claims.
Electronic Data Interchange (EDI) - Correct-answer-the computer-to-computer
transfer of data between providers and third-party payers in a data format agreed
upon by sending and receiving parties.
Covered Entities - Correct-answer-Process electronic claims and include all
private-sector health plans, managed care organizations, ERISA-covered health
benefit plans, government health plans, all health care clearinghouses, and all
health care providers that choose to submit or receive these transactions
electronically.
