HCAD 750 P2 EXAM QUESTIONS WITH CORRECT ANSWERS LATEST UPDATE 2025/2026
revenue cycle - Answers is the process that begins when a patient comes into the healthcare
system and includes those activities that have to occur in order for a provider of the care to bill
at the end of the patient's service encounter
The healthcare revenue cycle encompasses - Answers people, tools, methodologies, and
techniques that medical institutions use to manage their patients' financial status
Revenue management lifecycle - Answers is a complex process that involves balancing people,
processes, technology, and the environment in which the processes take place
revenue management life-cycle can be broken down into 3 phases - Answers the front-end,
middle, and back end
Front end of the revenue cycle includes - Answers patient access functions such as scheduling
of the patient for services, registration of the patient, prior or preauthorization for services,
insurance verification, service estimates, and financial counseling
middle process of the revenue cycle includes - Answers case management, capture of charges
for the services rendered, and coding for those services based on clinical documentation
back end of the revenue cycle is typically viewed as - Answers the business office or patient
financial service process and includes claims processing and payment posting, follow up,
customer service, collections of unpaid bills, and denial management
insurance verification - Answers is a vital component of the prearrival process for scheduled
patients; it entails validating that the patient is a member of the insurance plan given and is
covered for the scheduled service date
preauthorization is also referred to as ___ and is the requirement that a - Answers prior approval,
authorization, precertification, or predetermination; healthcare provider obtain permission from
the health insurer prior to predefined services being provided to the patients
financial counselors - Answers are staff dedicated to helping patients and physicians determine
sources of reimbursement for healthcare services
charity care - Answers defined as healthcare services that have been or will be provided but are
never expected to result in cash inflows
point of service collection - Answers is defined as the collection of the portion of the bill that is
likely the responsibility of the patient prior to the provision of service
medical necessity - Answers a determination that a services is reasonable and necessary for
the related diagnosis or treatment of illness or injury
national coverage determinations - Answers medicares national coverage policies are known as
, local coverage determinations - Answers local fiscal intermediary policies are known as
These policies define the specific international classification of diseases diagnosis codes that
support medical necessity for many services provided: - Answers national coverage
determinations and local coverage determinations
steerage - Answers is when an insurer provides financial incentive or discounted rates to a
facility to obtain a flow of patients it would not otherwise receive
case management - Answers defined as a collaborative process of assessment, planning,
facilitation, care coordination, evaluation, and advocacy for options and services to meet an
individuals and family's comprehensive health needs through communication and available
resources to promote quality cost effective outcomes
utilization management - Answers is the evaluation of the medical necessity, appropriateness,
and efficiency of the use of healthcare services, procedures, and facilities under the provisions
of the applicable health benefits plan; sometimes known as utilization review
utilization review staff - Answers is responsible for the day to day provisions of the hospitals
utilization plan as required by the medicare conditions of participation
charge capture - Answers is a method of recording services and supplies or items delivered to
the patient and directing them to be billed on a claim form. It is the process of documenting,
posting, and reconciling the charges for services rendered to patients.
claims scrubber software - Answers designed to detect errors that would result in payer denials
bill hold - Answers each facility has a defined number of these days. These are the number of
days in which accounts will be held from billing so charges can be entered after the patient is
discharged
facility charge - Answers allows capture of an E/M charge that represents those resources not
included with the CPT code for the clinic environment
charge description master - Answers is an electronic file that represents a master list of all
services, supplies, devices, and medications charged for inpatient or outpatient services.
Contains the basic elements for identifying, coding, and billing items and services provided to
patients, and it is the mechanism for representing captured charges on the billing claim
clinical documentation improvement - Answers programs to assist the health record accurately
reflects the actual condition of the patient
discharged, no final bill (DFNB) - Answers a bill cannot be generated until the coding is complete
so organizations routinely monitor these
case mix index - Answers is measured and analyzed. allows an org to compare its cost of
revenue cycle - Answers is the process that begins when a patient comes into the healthcare
system and includes those activities that have to occur in order for a provider of the care to bill
at the end of the patient's service encounter
The healthcare revenue cycle encompasses - Answers people, tools, methodologies, and
techniques that medical institutions use to manage their patients' financial status
Revenue management lifecycle - Answers is a complex process that involves balancing people,
processes, technology, and the environment in which the processes take place
revenue management life-cycle can be broken down into 3 phases - Answers the front-end,
middle, and back end
Front end of the revenue cycle includes - Answers patient access functions such as scheduling
of the patient for services, registration of the patient, prior or preauthorization for services,
insurance verification, service estimates, and financial counseling
middle process of the revenue cycle includes - Answers case management, capture of charges
for the services rendered, and coding for those services based on clinical documentation
back end of the revenue cycle is typically viewed as - Answers the business office or patient
financial service process and includes claims processing and payment posting, follow up,
customer service, collections of unpaid bills, and denial management
insurance verification - Answers is a vital component of the prearrival process for scheduled
patients; it entails validating that the patient is a member of the insurance plan given and is
covered for the scheduled service date
preauthorization is also referred to as ___ and is the requirement that a - Answers prior approval,
authorization, precertification, or predetermination; healthcare provider obtain permission from
the health insurer prior to predefined services being provided to the patients
financial counselors - Answers are staff dedicated to helping patients and physicians determine
sources of reimbursement for healthcare services
charity care - Answers defined as healthcare services that have been or will be provided but are
never expected to result in cash inflows
point of service collection - Answers is defined as the collection of the portion of the bill that is
likely the responsibility of the patient prior to the provision of service
medical necessity - Answers a determination that a services is reasonable and necessary for
the related diagnosis or treatment of illness or injury
national coverage determinations - Answers medicares national coverage policies are known as
, local coverage determinations - Answers local fiscal intermediary policies are known as
These policies define the specific international classification of diseases diagnosis codes that
support medical necessity for many services provided: - Answers national coverage
determinations and local coverage determinations
steerage - Answers is when an insurer provides financial incentive or discounted rates to a
facility to obtain a flow of patients it would not otherwise receive
case management - Answers defined as a collaborative process of assessment, planning,
facilitation, care coordination, evaluation, and advocacy for options and services to meet an
individuals and family's comprehensive health needs through communication and available
resources to promote quality cost effective outcomes
utilization management - Answers is the evaluation of the medical necessity, appropriateness,
and efficiency of the use of healthcare services, procedures, and facilities under the provisions
of the applicable health benefits plan; sometimes known as utilization review
utilization review staff - Answers is responsible for the day to day provisions of the hospitals
utilization plan as required by the medicare conditions of participation
charge capture - Answers is a method of recording services and supplies or items delivered to
the patient and directing them to be billed on a claim form. It is the process of documenting,
posting, and reconciling the charges for services rendered to patients.
claims scrubber software - Answers designed to detect errors that would result in payer denials
bill hold - Answers each facility has a defined number of these days. These are the number of
days in which accounts will be held from billing so charges can be entered after the patient is
discharged
facility charge - Answers allows capture of an E/M charge that represents those resources not
included with the CPT code for the clinic environment
charge description master - Answers is an electronic file that represents a master list of all
services, supplies, devices, and medications charged for inpatient or outpatient services.
Contains the basic elements for identifying, coding, and billing items and services provided to
patients, and it is the mechanism for representing captured charges on the billing claim
clinical documentation improvement - Answers programs to assist the health record accurately
reflects the actual condition of the patient
discharged, no final bill (DFNB) - Answers a bill cannot be generated until the coding is complete
so organizations routinely monitor these
case mix index - Answers is measured and analyzed. allows an org to compare its cost of
