CHSA Healthcare Finance & Revenue Cycle Flashcards

Which document outlines the itemized charges for services rendered to a patient during a hospital stay?

Answer: Uniform Bill (UB-04)

The UB-04 is the standardized claim form used by hospitals to bill institutional services to Medicare, Medicaid, and private insurers.

What term describes the process of verifying a patient's insurance coverage and benefits before providing non-emergency care?

Answer: Pre-certification/eligibility verification

Pre-certification and eligibility verification confirm that the patient's plan is active and covers the planned services before care is delivered.

Under Medicare's Prospective Payment System (PPS), hospital reimbursement for inpatient stays is primarily based on:

Answer: Diagnosis-Related Groups (DRGs)

DRGs group patients with similar diagnoses and expected resource use, and Medicare pays a fixed rate per DRG rather than per service.

A charge that a healthcare organization writes off because it exceeds the contracted payer rate is called a:

Answer: Contractual adjustment

A contractual adjustment is the difference between a provider's billed charge and the negotiated rate the payer is obligated to pay.

Which revenue cycle metric measures the average number of days it takes to collect payment after a service is billed?

Answer: Days in accounts receivable (AR)

Days in AR measures how efficiently a healthcare organization converts billed services into cash, with lower values indicating faster collections.

What is the purpose of a Medicare Cost Report submitted annually by hospitals?

Answer: To reconcile actual costs with interim payments received from Medicare

The Medicare Cost Report reconciles the hospital's actual costs of providing care to Medicare beneficiaries against the interim payments already received during the year.