Revenue Cycle Management Test Questions and Answers
Revenue Cycle Management/Accounts Receivable
Management - -The process by which health care Metrics - -Standards of measurement
facilities and providers ensure their financial viability by
increasing revenue, improving cash flow, and enhancing the
patient's experience. Revenue Cycle Auditing - -An assessment process that is
conducted as a follow-up to revenue cycle monitoring so that
areas of poor performance can be identified and corrected.
Claims Rejections - -Unpaid claims that fail to meet
certain data.
Resource Allocation - -Distribution of financial resources
among competing groups.
Claims Denials - -Unpaid claims that contain beneficiary
identification errors, coding errors, diagnoses that do not
support medical necessity of procedures/services performed, Resource Allocation Monitoring - -Uses data analytics to
duplicate claims, global days of surgery E/M coverage issues, measure whether a health care provider or organization
national correct coding initiative edits and outpatient code editor achieves operational goals and objectives within the confines of
issues, and other patient coverage issues. the distribution of financial resources, such as appropriately
expending budgeted amounts as well as conserving resources
and protecting assets while providing quality patient care.
Quarterly Provider Updates (QPUs) - -Regulations and
major policies implemented or cancelled, new and revised
manual instructions, regulations that establish or modify the way Data Analytics - -Tools and systems that are used to
CMS administers its programs. analyze clinical and financial data, conduct research, and
evaluate the effectiveness of disease treatments.
Utilization Management/Utilization Review - -Method of
controlling healthcare cost and quality of care by reviewing the Data Warehouses - -Databases that use reporting
appropriateness and necessity of care provided to patients prior interfaces to consolidate multiple databases, allowing reports to
to the administration of care or after care has been provided. be generated from a single request.
Prospective Review - -Prior to the administration of care. Data Mining - -Extracting and analyzing data to identify
patterns, whether predictable or unpredictable.
Retrospective Review - -After care has been provided.
Encounter Form/Superbill - -Financial record source
document used by health care providers and other personnel to
Preadmission Certification (PAC)/Preadmission Review - record treated diagnoses and services rendered to the patient
-Review for medical necessity of inpatient care prior to during the current encounter.
the patient's admission.
Chargemaster/Charge Description Master (CDM) - -
Preauthorization/Precertification/Prior Approval/ Prior Document that contains a computer-generated list of
Authorization - -Review by health plans to grant prior procedures, services, and supplies with charges for each.
approval for reimbursement of health care services.
Revenue Code - -A four-digit code preprinted on a
Concurrent Review - -Review for medical necessity of facility's chargemaster to indicate the location or type of service
tests and procedures ordered during an inpatient provided to an institutional patient.
hospitalization.
Chargemaster Maintenance - -Process of updating and
Discharge Planning - -Arranging appropriate healthcare revising key elements of the chargemaster to ensure accurate
services for the discharged patient. reimbursement.
Revenue Cycle Monitoring - -Assessing the revenue cycle Chargemaster Team - -Jointly shares the responsibility of
to ensure financial viability and stability using metrics. updating and revising the chargemaster to ensure its accuracy
and consists of representatives of a variety of departments, such
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Revenue Cycle Management/Accounts Receivable
Management - -The process by which health care Metrics - -Standards of measurement
facilities and providers ensure their financial viability by
increasing revenue, improving cash flow, and enhancing the
patient's experience. Revenue Cycle Auditing - -An assessment process that is
conducted as a follow-up to revenue cycle monitoring so that
areas of poor performance can be identified and corrected.
Claims Rejections - -Unpaid claims that fail to meet
certain data.
Resource Allocation - -Distribution of financial resources
among competing groups.
Claims Denials - -Unpaid claims that contain beneficiary
identification errors, coding errors, diagnoses that do not
support medical necessity of procedures/services performed, Resource Allocation Monitoring - -Uses data analytics to
duplicate claims, global days of surgery E/M coverage issues, measure whether a health care provider or organization
national correct coding initiative edits and outpatient code editor achieves operational goals and objectives within the confines of
issues, and other patient coverage issues. the distribution of financial resources, such as appropriately
expending budgeted amounts as well as conserving resources
and protecting assets while providing quality patient care.
Quarterly Provider Updates (QPUs) - -Regulations and
major policies implemented or cancelled, new and revised
manual instructions, regulations that establish or modify the way Data Analytics - -Tools and systems that are used to
CMS administers its programs. analyze clinical and financial data, conduct research, and
evaluate the effectiveness of disease treatments.
Utilization Management/Utilization Review - -Method of
controlling healthcare cost and quality of care by reviewing the Data Warehouses - -Databases that use reporting
appropriateness and necessity of care provided to patients prior interfaces to consolidate multiple databases, allowing reports to
to the administration of care or after care has been provided. be generated from a single request.
Prospective Review - -Prior to the administration of care. Data Mining - -Extracting and analyzing data to identify
patterns, whether predictable or unpredictable.
Retrospective Review - -After care has been provided.
Encounter Form/Superbill - -Financial record source
document used by health care providers and other personnel to
Preadmission Certification (PAC)/Preadmission Review - record treated diagnoses and services rendered to the patient
-Review for medical necessity of inpatient care prior to during the current encounter.
the patient's admission.
Chargemaster/Charge Description Master (CDM) - -
Preauthorization/Precertification/Prior Approval/ Prior Document that contains a computer-generated list of
Authorization - -Review by health plans to grant prior procedures, services, and supplies with charges for each.
approval for reimbursement of health care services.
Revenue Code - -A four-digit code preprinted on a
Concurrent Review - -Review for medical necessity of facility's chargemaster to indicate the location or type of service
tests and procedures ordered during an inpatient provided to an institutional patient.
hospitalization.
Chargemaster Maintenance - -Process of updating and
Discharge Planning - -Arranging appropriate healthcare revising key elements of the chargemaster to ensure accurate
services for the discharged patient. reimbursement.
Revenue Cycle Monitoring - -Assessing the revenue cycle Chargemaster Team - -Jointly shares the responsibility of
to ensure financial viability and stability using metrics. updating and revising the chargemaster to ensure its accuracy
and consists of representatives of a variety of departments, such
1/4
