RHIT Revenue Cycle Management 2 — Questions and Answers
Question 1: Which term describes the process of verifying a patient's insurance coverage before providing services?
- Claim adjudication
- Prior authorization
- Eligibility verification (Correct answer)
- Remittance posting
Correct answer: Eligibility verification
Eligibility verification confirms a patient's active insurance coverage and benefits before services are rendered.
Question 2: A claim is denied because the procedure code does not match the diagnosis code. This is an example of which type of edit?
- Duplicate claim edit
- Medical necessity edit
- Medically unlikely edit (MUE)
- National Correct Coding Initiative (NCCI) edit (Correct answer)
Correct answer: National Correct Coding Initiative (NCCI) edit
NCCI edits prevent improper payment of procedures that should not be billed together or when a procedure is incompatible with the diagnosis.
Question 3: What is the purpose of a charge description master (CDM)?
- To record patient demographic information
- To list all billable services with corresponding codes and prices (Correct answer)
- To track denied claims by payer
- To document physician credentials
Correct answer: To list all billable services with corresponding codes and prices
The CDM (chargemaster) is a comprehensive list of services, procedures, and supplies with associated billing codes and prices used for claim generation.
Question 4: Which federal program uses the Inpatient Prospective Payment System (IPPS) for hospital reimbursement?
- Medicaid
- TRICARE
- Medicare (Correct answer)
- CHIP
Correct answer: Medicare
Medicare uses IPPS to reimburse acute care hospitals a predetermined rate based on the patient's MS-DRG assignment.
Question 5: A hospital receives payment less than the billed amount with an explanation listing contractual adjustments. What should the HIM professional do with the difference?
- Bill the patient for the remainder
- Write it off as a contractual adjustment (Correct answer)
- Resubmit the claim to the payer
- Escalate to the compliance officer
Correct answer: Write it off as a contractual adjustment
Contractual adjustments represent the difference between billed charges and the negotiated rate and must be written off per the payer contract.
Question 6: Which metric measures the average number of days it takes to collect payment after a service is provided?
- Accounts receivable days (AR days) (Correct answer)
- Clean claim rate
- Denial rate
- Net collection rate
Correct answer: Accounts receivable days (AR days)
AR days (days in accounts receivable) measures the average time from service delivery to payment receipt, with lower values indicating faster collections.
Question 7: When a payer recoup funds previously paid to a provider due to an audit finding, this action is called a:
- Coordination of benefits
- Overpayment recovery or clawback (Correct answer)
- Secondary billing
- Claim adjustment
Correct answer: Overpayment recovery or clawback
Overpayment recovery (clawback) occurs when a payer demands return of funds after determining a claim was paid incorrectly.
RHIT Revenue Cycle Management 2
Which term describes the process of verifying a patient's insurance coverage before providing services?