WGU C810 Section 1.1 Chap 8 Revenue Cycle Management fully solved 2023/2024

WGU C810 Section 1.1 Chap 8 Revenue Cycle ManagementRevenue Cycle - correct answer The sequence of processes to progress a patient account from creation to closing Revenue cycle management (RCM) - correct answer The strategy implemented to direct administrative and clinical functions associated with capturing, monitoring, and collecting of patient service revenue. How does Healthcare Information and Management Systems Society (HIMSS) define revenue cycle management (RCM)? - correct answer A healthcare organization's financial circulatory system and basic process of the organization securing reimbursement for the products and services rendered to their patients. What are the three general phases of the revenue life cycle? - correct answer The front end, middle and back end What components are part of the front-end process of the revenue cycle? - correct answer Patient access, including scheduling, preauthorization, insurance verification, point-of-service collection, and financial counseling. What components are part of the middle process of the revenue cycle? - correct answer Charge capture, chargemaster, case management, clinical documentation, and coding What components are part of the back-end process of the revenue cycle? - correct answer Claims processing and payment posting, follow-up, collections, and denial manangement. What does preregistration involve? - correct answer Confirming eligibility and insurance benefits, which includes preauthorization and precertification activities, prior to the planned date-of-service visit. What does the insurance verification process entail? - correct answer -validating that the patient is a member of the insurance -the pt is covered for the scheduled service date -whether the pt insurance plan is in-network vs out-of-network -whether the scheduled service expenses will be covered -whether a referral or an authorization is required prior to the service being rendered -whether the patient will incur an out-of-pocket expense Preauthorization - correct answer Prior approval for treatment and procedures Precertification - correct answer When the insurance carrier must review the proposed service or procedure and approve it as medically necessary before payment will be granted to the provider. How does the American Medical Association (AMA) define medical necessity? - correct answer Health care services or prudent physicians would provide to a patient for the purposes of preventing diagnosing or treating an illness, injury, disease, or its symptoms in a manner that is (a) in accordance with accepted standards of medical practice (b) clinically appropriate in terms of type, frequency, extent, site, and duration and (c) not primarily for the economic benefit of the health plans and purchasers or for the convenience of the patient, treating physician or other health care provider How does Medicare define medical necessity? - correct answer A determination that a service is reasonable and necessary for the related diagnosis or treatment of illness or injury. National Coverage Determination (NCD) - correct answer Medicare's national coverage policies Medicare Administrative Contractor (MAC) - correct answer A private healthcare insurer that has been awarded a geographic jurisdiction to process Medicare Part A and Part B medical claims for Medicare Original beneficiaries. Local Coverage Determination (LCD) - correct answer A local Medicare Administrative Contractor policy. Advance Beneficiary Notice of Noncoverage (ABN) - correct answer A written notice to inform patients when an outpatient item or service is not considered reasonable and necessary or may not be covered. Hospital-Issued Notice of Noncoverage (HINN): - correct answer Provided to patients when an inpatient