Deck 11: Revenue Cycle Management

Question 1

Some healthcare providers lose a huge amount of revenue because ____.

A) they do not refile denied claims
B) they collect patient charges at time of service
C) their patients use invalid credit cards
D) electronic claims clearinghouses miscode their claims

Answer 1

they do not refile denied claims

Question 2

A patient does not have insurance coverage for a medical service performed. The patient cannot pay the full charge for the service. What should the medical facility staff member responsible for patient billing do first?

A) Contact a collection agency.
B) Offer a discount on the charge.
C) Negotiate flexible payment terms.
D) Classify the service as charity care and seek a tax deduction.

Answer 2

Negotiate flexible payment terms.

Question 3

Approximately 20% of medical revenues come from private-pay (self-pay) patients.

Answer 3

False

Question 4

Which of the following is the primary responsibility of a medical facility's on-site coding expert?

A) Encrypting electronic medical records to keep them secure
B) Ensuring that staff members properly use CPT and ICD-9 codes
C) Checking coding changes monthly
D) Submitting new CPT codes to the American Medical Association

Question 5

Which of the following is a goal of revenue cycle management?

A) maximizing accounts receivable
B) increasing staff to improve patient flow
C) paying bills on time
D) minimizing time between providing service and getting paid

Question 6

Under which of the following circumstances is it most important for a medical facility to know its marginal cost per patient visit?

A) When a clinician partner plans to leave and patient load per year will fall
B) When renegotiating a contract with a healthcare insurer
C) When hiring a new office manager
D) When the facility expects to add patients

Question 7

Which of the following medical practices would get the least benefit from contracting with an electronic claim clearinghouse?

A) A practice with 90% Medicare patients and 9% Blue Shield patients
B) A practice with 90% insured patients with the biggest insurer covering 20%.
C) A hospital with no significant responsibility for patient care
D) A practice with an equal mix of Medicare, Medicaid, and Blue Shield patients

Question 8

The best process for a medical practice to confirm a patient's appointment is to mail a postcard ten days before the scheduled appointment.

Question 9

Healthcare insurance companies can contribute to cash flow problems at medical facilities by ____.

A) delaying reimbursements as much as possible
B) under-coding submitted claims
C) losing paperwork
D) telling beneficiaries not to pay deductibles at the time of service

Question 10

What is an under-code on a claim for medical services?

A) Misreading a table and choosing the code underneath the correct code
B) Deliberately entering a code for a service that pays less
C) An insurance company ploy to underpay for medical services
D) A subcategory of a procedure indicated with an added decimal,
E)g, 987.1

Question 11

It is always legal and ethical to dismiss a patient who will not pay for a medical service that was performed.

Question 12

A healthcare insurance company submits a proposed contract to a medical provider. The payments in the proposed contract are 20-40% lower than any other third-party payer, and the insurance company refuses to negotiate. This insurance company is used by 9% of the medical practice's patients. Which of the following is the best option for the facility?

A) Contact other local medical facilities and negotiate together.
B) Do not sign the contract and write a letter to the affected patients.
C) Sign the contract if the payments are close to average marginal costs per patient.
D) Sue the healthcare insurance company.

Question 13

What is the next step a medical facility should take after completing a medical service claim form?

A) Send it to the appropriate healthcare insurance company.
B) Send it to the patient for verification.
C) Perform a quality control review of the claim form.
D) Send it to the in-house coding expert to verify current codes.

Question 14

A CPT (Common Procedural Terminology) code is ____.

A) a five digit code of the patient's diagnosis
B) a five digit code of the medical service provided
C) a ###.## code of the patient's diagnosis
D) a ###.## code of the medical service provided

Question 15

A medical practice finds that during busy periods it cannot keep up with checking-in patients. Which of the following is the most cost-effective option?

A) Hire a part-time worker to help with check-ins.
B) Decrease the number of patient appointments per day.
C) Crosstrain other workers on check-in procedures
D) During busy periods, ask if any patients are willing to reschedule.

Question 16

If pre-certification for a medical service is not obtained, who is always responsible for the cost of the service?

A) the patient
B) the insurer
C) the medical facility
D) it varies

Question 17

The numbers in each choice are the percentages of total receivables as follows: Receivables < 30 days old, 31-60 days old, and > 60 days old, respectively. Which of the following results represents the best cash flow?

A) 75, 15, 10
B) 30, 33, 37
C) 40, 45, 15
D) 50, 30, 20

Question 18

An explanation of benefits (EOB) is a statement sent by a healthcare insurance company to a patient describing the medical service performed, the charge from the medical facility, the allowable charge based on the insurance contract, and the amount owed by the patient.

Question 19

A patient objects to a medical practice's new policy of requiring deductible payments and co-payments at the time of service. Which of the following would be the best response by the staff?

A) Other service providers such as hairstylists get paid at the time of service.
B) By paying now, you won't have to worry about a future bill.
C) Paying now helps keep our costs down so our charges won't go up as much.
D) At least we're not like a repair shop that keeps your car until the bill is paid.

Question 20

Pre-certification is the temporary accreditation of a new medical facility.

Question 21

Describe the benefits of expediting cash flow in a medical facility.

Question 22

Describe the financial effects to a medical facility of missed appointments.

Question 23

What is the financial reason for a medical facility patient appointment scheduler to estimate the amount of time each appointment will require?

A) A missed appointment increases costs per day.
B) More patients will pay at the time of service.
C) Under-coding will not occur.
D) Optimum scheduling allows maximum physician efficiency.

Question 24

What tasks should be performed by medical facility reception staff when a patient arrives for a scheduled medical service?

Question 25

Which of the following would be included in the accounting balance in accounts recievable?

A) Amount owed by patient after insurance payment received
B) Value of charity provided
C) Amount medical facility owes to vendors
D) Amount patients paid at the time of service

Question 26

The best time to collect money owed by the patient for medical services is at the ____________________.

Question 27

Describe the calculation of and use of the average marginal cost per patient at a medical facility.

Question 28

A patient with healthcare insurance may owe the full charge for a covered medical service because the insurance coverage has a(n) ____________________.

Question 29

What are the downsides of turning a patient's account over to a collection agency?

Question 30

Private-pay patients ____.

A) are those with private health insurance
B) will only discuss payments in private
C) are responsible for the full costs of medical services received
D) are the majority of patients at primary care practices

Question 31

Medical practices that have difficulty handling claims for dozens of healthcare insurers can use a(n) ____________________.

Question 32

Revenue cycle management is concerned with ____.

A) how business cycle fluctuations affect revenues
B) collecting revenues quickly and efficiently
C) handling seasonally-related (cyclical) differences in patients seen per day
D) revolving charge accounts for operations

Question 33

A medical practice completely revises its financial policies. It is important that the facility's staff be ____________________.

Question 34

The basis for reimbursement from a healthcare insurance company for medical services provided by a clinician is the ____________________.

Question 35

Historically in the United States, relationships between clinicians and healthcare insurers have been ____.

A) harmonious and mutually satisfactory
B) one-way, with insurers dictating terms
C) one-way, with clinicians dictating terms
D) disastrous, with both groups losing money