THE REVENUE CYCLE & REVENUE
CYCLE MANAGEMENT EXAM 2025
QUESTIONS AND ANSWERS
Definition of Revenue Cycle Management (RCM) - ANS is the supervision of all administrative
and clinical functions that contribute to the capture, management and collection of patient
service revenue.
Pre-Claims Submission Activities -
ANS PreAdmit/Scheduling/Admissions/Registration/Patient Access Service/Front End
Processes
Case Management/Utilization Review - ANS a.Inpatient Medical Necessity (Admission
Criteria)
b.Determination of Appropriate Level of Care
c.Procedural Pre-Certification
d.Medical Necessity for Ambulatory Diagnostic Testing
Charge Capture - ANS assure that billable services are charged
Electronic - ANS capture charge at point of service - order entry
Manual - ANS charge tickets processed daily
COPYRIGHT © 2025 BRAINBARTER ALL RIGHTS RESERVED 1
, Coding Patient Records - ANS Best Practice - 98% accuracy
Hard Coded - ANS Charge Master - lab, xray, medications,
supplies, etc.
Manual Coding - ANS HIM Department - all diagnoses and
significant procedures
Scrubber - ANS internal auditing - prior to claims submission
and Payer Auditing of Submitted Claim
Outpatient Code Editor (OCE) - ANS Edits Data/Claims Disposition
Rejected Claim/Line Item - ANS Can be Corrected and Resubmitted
Denied Claim/Line Item - ANS Must be Appealed
Suspended - ANS usually awaiting additional information
Assigns OPPS Ambulatory Payment
Classification (APC) - ANS 1. CPT/HCPCS status indicators
2. APC
3. Payment indicator
a. Discounts
b. Packaging
COPYRIGHT © 2025 BRAINBARTER ALL RIGHTS RESERVED 2
CYCLE MANAGEMENT EXAM 2025
QUESTIONS AND ANSWERS
Definition of Revenue Cycle Management (RCM) - ANS is the supervision of all administrative
and clinical functions that contribute to the capture, management and collection of patient
service revenue.
Pre-Claims Submission Activities -
ANS PreAdmit/Scheduling/Admissions/Registration/Patient Access Service/Front End
Processes
Case Management/Utilization Review - ANS a.Inpatient Medical Necessity (Admission
Criteria)
b.Determination of Appropriate Level of Care
c.Procedural Pre-Certification
d.Medical Necessity for Ambulatory Diagnostic Testing
Charge Capture - ANS assure that billable services are charged
Electronic - ANS capture charge at point of service - order entry
Manual - ANS charge tickets processed daily
COPYRIGHT © 2025 BRAINBARTER ALL RIGHTS RESERVED 1
, Coding Patient Records - ANS Best Practice - 98% accuracy
Hard Coded - ANS Charge Master - lab, xray, medications,
supplies, etc.
Manual Coding - ANS HIM Department - all diagnoses and
significant procedures
Scrubber - ANS internal auditing - prior to claims submission
and Payer Auditing of Submitted Claim
Outpatient Code Editor (OCE) - ANS Edits Data/Claims Disposition
Rejected Claim/Line Item - ANS Can be Corrected and Resubmitted
Denied Claim/Line Item - ANS Must be Appealed
Suspended - ANS usually awaiting additional information
Assigns OPPS Ambulatory Payment
Classification (APC) - ANS 1. CPT/HCPCS status indicators
2. APC
3. Payment indicator
a. Discounts
b. Packaging
COPYRIGHT © 2025 BRAINBARTER ALL RIGHTS RESERVED 2
