AAPC Revenue Cycle Management 1 — Questions and Answers
Question 1: What is the first step in the healthcare revenue cycle?
- Patient registration and scheduling (Correct answer)
- Claim submission
- Payment posting
- Collections
Correct answer: Patient registration and scheduling
The revenue cycle begins with patient registration and scheduling, where demographic and insurance information is collected.
Question 2: A 'clean claim' in revenue cycle management refers to a claim that:
- Has been denied by the payer
- Contains all required information and passes edits for processing (Correct answer)
- Has been submitted more than once
- Has an outstanding balance
Correct answer: Contains all required information and passes edits for processing
A clean claim contains all required data elements, passes all edits, and is ready for adjudication without additional information needed.
Question 3: What is the primary purpose of eligibility verification in the revenue cycle?
- To calculate the provider's fee schedule
- To confirm a patient's insurance coverage before services are rendered (Correct answer)
- To submit claims to payers
- To post payments to patient accounts
Correct answer: To confirm a patient's insurance coverage before services are rendered
Eligibility verification confirms the patient's insurance benefits and coverage details prior to service to prevent claim denials.
Question 4: What document does a payer send to explain how a claim was processed and paid?
- Superbill
- Remittance advice (ERA/EOB) (Correct answer)
- Charge master
- Patient statement
Correct answer: Remittance advice (ERA/EOB)
A remittance advice (electronic or paper EOB) details payment decisions, adjustments, and denial reasons for submitted claims.
Question 5: What does 'days in accounts receivable (AR)' measure in revenue cycle management?
- The number of claims denied per day
- The average number of days it takes to collect payment after service (Correct answer)
- The total number of outstanding claims
- The percentage of claims paid on first submission
Correct answer: The average number of days it takes to collect payment after service
Days in AR measures the average time from service date to payment receipt, indicating the efficiency of the billing cycle.
Question 6: In revenue cycle management, a 'write-off' refers to:
- An increase in the billed amount
- An amount removed from accounts receivable that cannot be collected (Correct answer)
- A payment made by the patient
- A claim resubmission
Correct answer: An amount removed from accounts receivable that cannot be collected
A write-off is an amount that is adjusted off the account because it is contractually disallowed or deemed uncollectable.
AAPC Revenue Cycle Management 1
What is the first step in the healthcare revenue cycle?