Revenue Cycle Management Flashcards
7 cards from real AHIMA practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Revenue Cycle Management flashcards as text
What is the primary role of patient access in the revenue cycle?
Answer: Capturing accurate demographic and insurance information to support clean claim submission
Patient access is the front end of the revenue cycle; accurate registration and eligibility data gathered here directly determines downstream billing accuracy.
In a bundled payment reimbursement model, how are providers typically paid?
Answer: A single payment covers all services related to a defined episode of care
Bundled payments consolidate reimbursement for all providers and services within a defined care episode into a single payment, incentivizing coordination.
What is the purpose of obtaining prior authorization before providing a service?
Answer: To confirm that the payer will cover a specific service before it is rendered
Prior authorization is the payer's advance approval that a service will be covered, reducing the risk of a medical necessity or non-covered service denial.
What does an Accountable Care Organization (ACO) shared savings model incentivize?
Answer: Care coordination and cost reduction below a benchmark, with shared savings distributed to providers
ACO shared savings models reward providers for coordinating care, improving quality, and keeping total costs below a pre-established benchmark.
In revenue cycle management, what does a 'write-off' most commonly represent?
Answer: The difference between the billed charge and the payer's contractual allowance, or an uncollectible bad debt balance
Write-offs include contractual adjustments (required by payer contracts) and bad debt (uncollectible balances after collection efforts are exhausted).
Which step in the revenue cycle involves recording payer payments and adjustments to individual patient accounts?
Answer: Payment posting
Payment posting is the process of entering payments, contractual adjustments, and denials received via ERA or paper remittance into the practice management system.
Why must credit balances in patient accounts be resolved promptly in revenue cycle management?
Answer: Unresolved credit balances represent overpayments that must be refunded to patients or payers to maintain regulatory compliance
Credit balances result from overpayments and must be identified and refunded promptly; retaining them constitutes improper retention of federal funds when Medicare or Medicaid overpaid.