TEST BANK
Revenue Cycle for Healthcare, 1st Edition
by Linda Parks
SC
O
R
EG
U
ID
ES
,TABLE OF CONTENT
Chapter 1. Overview of Revenue Cycle Management
Chapter 2. Reimbursement Processes and Tools
Chapter 3. Healthcare Finance Information as A Strategic Resource
Chapter 4. Inpatient Prospective Payment Systems
SC
Chapter 5. Outpatient Prospective Payment Systems
Chapter 6. Measures of Hospital Performance
O
Chapter 7. Pay-for-Performance and Value-Based Purchasing
R
Chapter 8. Charge Description Master (CDM)
EG
Chapter 9. Clinical Documentation Integrity
Chapter 10. Physician Queries
Chapter 11. Claims, Denials, and Appeals
U
Chapter 12. Billing and Compliance Audits
ID
ES
,Name Class Dat
: : e:
Chapter 01 Overview of Revenue Cycle Management
1. What is the first step of the life cycle of a payment claim?
a. The patient checks in at the front desk.
b. Denials and appeals have been closed.
c. Coinsurance payments are met.
d. Treatment plans have been identified.
ANSWER: a
SC
FEEDBACK: a. Correct. The revenue cycle is the life cycle of a payment claim that begins when the
patient checks in at the front desk and ends after all payments or denials and appeals
have been made.
b. Incorrect. The revenue cycle ends when all payments or denials and appeals have
been made.
c. Incorrect. Coinsurance is the percentage the patient pays for covered services after the
deductible has been met and the copay has been paid.
O
d. Incorrect. Bills must accurately describe the treatment or service so that the claim can
be paid appropriately.
POINTS: 1
DIFFICULTY: Easy
R
REFERENCES: Introduction
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
EG
LEARNING OBJEC LO: 1.1 - Identify the steps in the revenue cycle.
TIVES:
OTHER: Bloom's: Understand
DATE CREATED: 6/2/2023 1:17 AM
DATE MODIFIED: 6/2/2023 1:20 AM
U
2. Why is it important that the process of managing billing cycles be performed accurately and on a timely basis?
a. to maintain cash flows
b. to ensure deductibles have been met
ID
c. to enable the organization to become a covered entity
d. to prevent Medicare abuse
ANSWER: a
FEEDBACK: a. Correct. Throughout the process of managing billing cycles, cash flow must be
maintained to enable health care facilities to deliver quality care to their patients and
ES
stay in business.
b. Incorrect. The insurance provider, not the provider of the service, will ensure that
deductibles have been met.
c. Incorrect. Health care organizations that are required to comply with HIPAA regulations
are known as covered entities (CE), and that definition includes all organizations that
electronically transmit any information that is protected under HIPAA.
d. Incorrect. Medicare defines abuse as “practices that directly or indirectly result in
unnecessary costs to Medicare.”
POINTS: 1
DIFFICULTY: Easy
REFERENCES: Introduction
Copyright Cengage Learning. Powered by Cognero. Page 1
, Name Class Dat
: : e:
Chapter 01 Overview of Revenue Cycle Management
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
LEARNING OBJEC LO: 1.1 - Identify the steps in the revenue cycle.
TIVES:
OTHER: Bloom's: Analyze
DATE CREATED: 6/2/2023 2:01 AM
SC
DATE MODIFIED: 6/2/2023 2:03 AM
3. How does HIPAA apply to the revenue cycle?
a. It protects patient information.
b. It tracks copays and deductibles for patients.
c. It indicates what a patient will owe for services.
O
d. It determines eligibility for Medicare and Medicaid.
ANSWER: a
FEEDBACK: a. Correct. HIPAA applies to the revenue cycle because it protects the transmission of
patient information as well as the privacy of the patient’s information as it is shared in
R
the business of reimbursing for services rendered.
b. Incorrect. Patients and their insurance companies must be billed for services in
accordance with the terms of their health insurance coverage, deductibles, copays, and
coinsurances.
EG
c. Incorrect. Coinsurance is the percentage the patient pays for covered services after the
deductible has been met and the copay has been paid.
d. Incorrect. Medicare and Medicaid are covered and monitored under amendments to the
Social Security Act.
POINTS: 1
DIFFICULTY: Easy
U
REFERENCES: HIPAA and the Revenue Cycle
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
ID
LEARNING OBJEC LO: 1.2 - Describe the role of HIPAA in the revenue cycle.
TIVES:
OTHER: Bloom's: Understand
DATE CREATED: 6/2/2023 2:03 AM
DATE MODIFIED: 6/2/2023 2:06 AM
ES
4. What is the role of health care clearinghouses in the revenue cycle?
a. to convert nonstandard transactions into standard ones
b. to transmit all information protected under HIPAA
c. to monitor the impact of privacy rules
d. to provide information to lessen imminent danger
ANSWER: a
FEEDBACK: a. Correct. Health care clearinghouses are companies that convert nonstandard
transactions into standard transactions and transmit the data to health plans and the
reverse process.
Copyright Cengage Learning. Powered by Cognero. Page 2
Revenue Cycle for Healthcare, 1st Edition
by Linda Parks
SC
O
R
EG
U
ID
ES
,TABLE OF CONTENT
Chapter 1. Overview of Revenue Cycle Management
Chapter 2. Reimbursement Processes and Tools
Chapter 3. Healthcare Finance Information as A Strategic Resource
Chapter 4. Inpatient Prospective Payment Systems
SC
Chapter 5. Outpatient Prospective Payment Systems
Chapter 6. Measures of Hospital Performance
O
Chapter 7. Pay-for-Performance and Value-Based Purchasing
R
Chapter 8. Charge Description Master (CDM)
EG
Chapter 9. Clinical Documentation Integrity
Chapter 10. Physician Queries
Chapter 11. Claims, Denials, and Appeals
U
Chapter 12. Billing and Compliance Audits
ID
ES
,Name Class Dat
: : e:
Chapter 01 Overview of Revenue Cycle Management
1. What is the first step of the life cycle of a payment claim?
a. The patient checks in at the front desk.
b. Denials and appeals have been closed.
c. Coinsurance payments are met.
d. Treatment plans have been identified.
ANSWER: a
SC
FEEDBACK: a. Correct. The revenue cycle is the life cycle of a payment claim that begins when the
patient checks in at the front desk and ends after all payments or denials and appeals
have been made.
b. Incorrect. The revenue cycle ends when all payments or denials and appeals have
been made.
c. Incorrect. Coinsurance is the percentage the patient pays for covered services after the
deductible has been met and the copay has been paid.
O
d. Incorrect. Bills must accurately describe the treatment or service so that the claim can
be paid appropriately.
POINTS: 1
DIFFICULTY: Easy
R
REFERENCES: Introduction
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
EG
LEARNING OBJEC LO: 1.1 - Identify the steps in the revenue cycle.
TIVES:
OTHER: Bloom's: Understand
DATE CREATED: 6/2/2023 1:17 AM
DATE MODIFIED: 6/2/2023 1:20 AM
U
2. Why is it important that the process of managing billing cycles be performed accurately and on a timely basis?
a. to maintain cash flows
b. to ensure deductibles have been met
ID
c. to enable the organization to become a covered entity
d. to prevent Medicare abuse
ANSWER: a
FEEDBACK: a. Correct. Throughout the process of managing billing cycles, cash flow must be
maintained to enable health care facilities to deliver quality care to their patients and
ES
stay in business.
b. Incorrect. The insurance provider, not the provider of the service, will ensure that
deductibles have been met.
c. Incorrect. Health care organizations that are required to comply with HIPAA regulations
are known as covered entities (CE), and that definition includes all organizations that
electronically transmit any information that is protected under HIPAA.
d. Incorrect. Medicare defines abuse as “practices that directly or indirectly result in
unnecessary costs to Medicare.”
POINTS: 1
DIFFICULTY: Easy
REFERENCES: Introduction
Copyright Cengage Learning. Powered by Cognero. Page 1
, Name Class Dat
: : e:
Chapter 01 Overview of Revenue Cycle Management
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
LEARNING OBJEC LO: 1.1 - Identify the steps in the revenue cycle.
TIVES:
OTHER: Bloom's: Analyze
DATE CREATED: 6/2/2023 2:01 AM
SC
DATE MODIFIED: 6/2/2023 2:03 AM
3. How does HIPAA apply to the revenue cycle?
a. It protects patient information.
b. It tracks copays and deductibles for patients.
c. It indicates what a patient will owe for services.
O
d. It determines eligibility for Medicare and Medicaid.
ANSWER: a
FEEDBACK: a. Correct. HIPAA applies to the revenue cycle because it protects the transmission of
patient information as well as the privacy of the patient’s information as it is shared in
R
the business of reimbursing for services rendered.
b. Incorrect. Patients and their insurance companies must be billed for services in
accordance with the terms of their health insurance coverage, deductibles, copays, and
coinsurances.
EG
c. Incorrect. Coinsurance is the percentage the patient pays for covered services after the
deductible has been met and the copay has been paid.
d. Incorrect. Medicare and Medicaid are covered and monitored under amendments to the
Social Security Act.
POINTS: 1
DIFFICULTY: Easy
U
REFERENCES: HIPAA and the Revenue Cycle
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
ID
LEARNING OBJEC LO: 1.2 - Describe the role of HIPAA in the revenue cycle.
TIVES:
OTHER: Bloom's: Understand
DATE CREATED: 6/2/2023 2:03 AM
DATE MODIFIED: 6/2/2023 2:06 AM
ES
4. What is the role of health care clearinghouses in the revenue cycle?
a. to convert nonstandard transactions into standard ones
b. to transmit all information protected under HIPAA
c. to monitor the impact of privacy rules
d. to provide information to lessen imminent danger
ANSWER: a
FEEDBACK: a. Correct. Health care clearinghouses are companies that convert nonstandard
transactions into standard transactions and transmit the data to health plans and the
reverse process.
Copyright Cengage Learning. Powered by Cognero. Page 2
