RHIT - Registered Health Information Technician Revenue Cycle Management 2 — Questions and Answers
Question 1: What is the first step in the healthcare revenue cycle?
- Claims submission
- Patient pre-registration and scheduling including insurance verification (Correct answer)
- Payment posting
- Accounts receivable follow-up
Correct answer: Patient pre-registration and scheduling including insurance verification
The revenue cycle begins with pre-registration, insurance verification, and eligibility confirmation.
Front-end errors are a leading cause of claim denials. Accurate insurance verification alone can prevent 20-30% of denials.
Question 2: What is the purpose of a remittance advice (RA)?
- To schedule appointments
- To communicate the payer's payment decision for each claim line including amounts paid and denial reasons (Correct answer)
- To verify patient identity
- To order supplies
Correct answer: To communicate the payer's payment decision for each claim line including amounts paid and denial reasons
A remittance advice provides detailed information about how the payer adjudicated each claim.
Revenue cycle staff analyze remittances to post payments, identify denials for appeal, track payer performance, and manage accounts receivable.
Question 3: What is the difference between a 'clean claim' and a 'rejected claim'?
- Clean claims are on white paper
- A clean claim has all required data and processes smoothly; a rejected claim has errors preventing processing (Correct answer)
- Clean claims are for Medicare
- There is no difference
Correct answer: A clean claim has all required data and processes smoothly; a rejected claim has errors preventing processing
A clean claim contains all required information for processing; a rejected claim has errors or missing data.
Industry benchmarks target clean claim rates above 95%. Tracking rejection reasons helps identify process improvements.
Question 4: What is accounts receivable (A/R) management?
- Managing savings accounts
- Tracking, managing, and collecting outstanding payments owed from payers and patients (Correct answer)
- Managing vendor invoices
- Tracking employee payroll
Correct answer: Tracking, managing, and collecting outstanding payments owed from payers and patients
A/R management involves tracking outstanding claims, following up on denials, and collecting balances.
Key metrics include Days in A/R (target under 40), A/R aging, net collection rate (target >95%), and denial rate (target <5%).
Question 5: What is the role of charge capture in the revenue cycle?
- To capture photographs
- To ensure all billable services are accurately documented and entered into the billing system (Correct answer)
- To record patient complaints
- To monitor parking charges
Correct answer: To ensure all billable services are accurately documented and entered into the billing system
Charge capture ensures every billable service and supply is recorded in the billing system.
Studies estimate 1-5% of hospital net revenue is lost to charge capture errors. Regular audits and reconciliation are essential.
Question 6: What is the purpose of the Recovery Audit Contractor (RAC) program?
- To help patients recover from illness
- To identify and recover improper Medicare payments through post-payment claim reviews (Correct answer)
- To recover stolen equipment
- To recruit healthcare workers
Correct answer: To identify and recover improper Medicare payments through post-payment claim reviews
RACs review Medicare claims post-payment to identify both overpayments and underpayments.
The appeal process has five levels: redetermination, reconsideration (QIC), ALJ hearing, Medicare Appeals Council, and federal court.
RHIT - Registered Health Information Technician Revenue Cycle Management 2
What is the first step in the healthcare revenue cycle?