Deck 10: Revenue Cycle Management

Question 1

In the past, in the fee-for-service approach to managing the financial side of healthcare reimbursement, it was:

A) fragmented.
B) contiguous.
C) departmentalized.
D) seamless.
E) both fragmented and departmentalized.

Answer 1

E

Question 2

The ______________________ entails payer negotiation that happens outside the patient encounter, the patient access component that includes the scheduling of the patient for inpatient or outpatient services, registration, insurance verification, obtaining prior authorization or a precertification if necessary, and patient financial counseling.

A) back-end process
B) middle process
C) front-end process
D) silo approach
E) None of these is correct.

Answer 2

C

Question 3

The ________________________ in the revenue cycle is where case management is involved, charge capture, and hard coding and soft coding of diagnoses and procedures that are all based on clinical documentation.

A) back-end process
B) middle process
C) front-end process
D) silo approach
E) None of these is correct.

Answer 3

B

Question 4

_____________________ is the first point of contact with the patient.

A) Patient scheduling
B) Insurance verification
C) Prior authorization
D) Financial counseling

Question 5

________________________ is the next step in the registration process; it is a critical element and can sometimes be electronic.

A) Patient scheduling
B) Insurance verification
C) Prior authorization
D) Financial counseling

Question 6

__________________ is/are a way in which the facility can choose to help a patient that is in need of services from the provider. This is not designed as a tool for people who refuse to pay; it is for people who have unplanned or unforeseen medical needs and do not have insurance or a means to pay for those services at the time of treatment.

A) Fee-for-service
B) Indigent care
C) Charity care
D) Both indigent care and charity care
E) None of these is correct.

Question 7

_________________________________ are "the collection of the portion of the bill that is likely the responsibility of the patient before the provision of services."

A) Point-of-service collections
B) Retrospective collections
C) Claim submissions
D) Consumer-driven health plans

Question 8

There are various tools that can support the front-end part of the revenue cycle that help capture data that aid in the securing of payment from the payers. These tools include all of the following, except:

A) location-wide scheduling system.
B) order tracking and management system.
C) registration quality assurance tools.
D) online third-party eligibility.
E) None of these is correct.

Question 9

The middle process "represents the intersection of ________________ and billing".

A) financial management
B) clinical practice
C) admissions staff
D) insurance verification

Question 10

___________________ is/are "a collaborative process of assessment, planning, facilitation, care coordination, evaluation and advocacy for option and services to meet an individual's and family's comprehensive health needs through communication and available resources to promote quality, cost-effective outcomes."

A) System tools
B) Medical necessity
C) Both systems tools and medical necessity
D) Case management

Question 11

_______________________ is "the evaluation of the medical necessity, appropriateness, and efficiency of the use of healthcare services, procedures, and facilitates these under the provisions of the applicable health benefits plan."

A) Case management
B) Clinical documentation improvement
C) Utilization management
D) Prior-authorization

Question 12

CMS requires that hospitals have the requirement to issue _____________________ to Medicare patients either prior to admission, during the admission, or at any point if the care that the patient is receiving is not covered due to medical necessity, not delivered in the most appropriate setting, or if it is custodial.

A) Advance Beneficiary Notices
B) Certificates of Medical Necessity
C) Hospital-Issued Notices of Noncoverage
D) All of these are correct.
E) Only Certificates of Medical Necessity and Hospital-Issued Notices of Noncoverage

Question 13

________________________ contains all necessary information that will identify the item used, the charge associated with it, and the code that is associated with it that will enable the system to place the information on the claim form that will be sent to the payer.

A) Charge capture
B) Claims processing
C) Claims scrubbing
D) Chart audit
E) Charge Description Master

Question 14

Payment posting is where the insurance company pays the claim that was submitted, and then once the facility receives payment, they can post the payment to the open accounts receivable. This posting:

A) reduces accounts receivable.
B) increases the cash account.
C) allows the biller to write off any nonpayment or short payment.
D) both reduces accounts receivable and increases the cash account.
E) None of these is correct.

Question 15

Increasing the RCM performance will have a ______________ impact on the overall health of the organization's financial condition.

A) neutral
B) negative
C) positive
D) varying

Question 16

In a retrospective environment, both the provider and payer worked after the fact, in that the provider would bill for all services rendered but not really know if all the work was covered; they would find this out when the payment came into the facility.

Question 17

In a prospective environment it is entirely up to the healthcare facility to manage their profit or loss with regard to a particular patient's hospital stay.

Question 18

In the front-end section of the RCM model, all of the processes are completed to ensure that the revenue that the facility is going to book will be collectable.

Question 19

Only in an emergency, the financial counselors should discuss and document the patient's responsibility for payment of any co-payment or deductible at the time of service and how they plan on paying the amounts that they are personally responsible for.

Question 20

The case manager looks to expedite all parts of the care process to make sure that there are no delays in care, delays in discharge, delays in admission to the next provider or facility, and no delays to the patient receiving the necessary treatment to continue progressing in the healing process or managing symptoms.

Question 21

Utilization management is sometimes called utilization review (UR) where staff is responsible "for the day-to-day provisions of the hospital's utilization plan as required by the Medicare Conditions of Participation."

Question 22

The maintenance of the CDM is a single disciplinary activity and requires one person or department to have oversight.

Question 23

The Correct Coding Initiative (CCI), along with the Local Medical Review Policy (LMRP) and National Coverage Determination (NCD), edits need to be applied at the time of the original transaction taking place in the billing system and CDM.

Question 24

Claims processing involves the totaling of charges for all services that a patient has incurred during their encounter. Once a patient has been discharged, the goal of the facility is to get a complete and accurate claim generated and submitted for payment to the payer.

Question 25

Denials are responses by the payer that the claim is either incorrect or the billed amount is not representative of the services documented in the patient record. Sometimes, it is as simple as a missing modifier or incorrect patient identification number.