#1
What is the primary goal of Healthcare Revenue Cycle Management?
Ensuring timely payment for services
ExplanationOptimizing revenue collection processes.
#2
What is the primary purpose of a Healthcare Compliance Officer?
Ensuring adherence to healthcare laws and regulations
ExplanationEnsuring compliance with healthcare laws.
#3
Which entity is responsible for assigning National Provider Identifiers (NPIs) to healthcare providers?
Centers for Medicare & Medicaid Services (CMS)
ExplanationAssigning unique identifiers to healthcare providers.
#4
Which organization plays a key role in developing and maintaining healthcare code sets, including CPT and HCPCS Level II codes?
American Medical Association (AMA)
ExplanationResponsible for healthcare coding standards.
#5
Which government agency oversees the administration of the Medicare program in the United States?
Centers for Medicare & Medicaid Services (CMS)
ExplanationResponsible for managing Medicare program operations.
#6
Which administrative process involves verifying a patient's insurance coverage before providing healthcare services?
Pre-authorization
ExplanationConfirming insurance eligibility prior to treatment.
#7
What does the term 'Claim Denial' refer to in the healthcare revenue cycle?
Rejection of a submitted insurance claim
ExplanationInsurance refusal of a payment request.
#8
What is the purpose of a Remittance Advice (RA) in the healthcare revenue cycle?
Explaining the reasons for claim denials or adjustments
ExplanationDocumentation of claim rejection explanations.
#9
In the context of healthcare billing, what is the meaning of 'UB-04'?
A billing form used for institutional claims
ExplanationStandardized billing form for institutional claims.
#10
What is the significance of the ICD-10 coding system in healthcare?
A diagnostic and procedural code classification system
ExplanationStandard coding system for diagnoses and procedures.
#11
What role does the Accounts Receivable (AR) department play in the healthcare revenue cycle?
Handling billing and payments from insurance companies
ExplanationResponsible for managing insurance payments.
#12
In the context of healthcare revenue cycle, what does 'Charge Description Master (CDM)' represent?
A list of medical procedures and their corresponding charges
ExplanationCatalog of medical service costs.
#13
What is the role of a Health Information Management (HIM) professional in healthcare revenue cycle?
Billing and coding for medical procedures
ExplanationResponsible for medical coding and billing tasks.
#14
What does the term 'Clearinghouse' refer to in healthcare revenue cycle management?
A centralized system for processing and validating claims
ExplanationCentralized claim processing and validation system.
#15
Which regulatory body oversees the implementation of HIPAA (Health Insurance Portability and Accountability Act) in the United States?
Office for Civil Rights (OCR)
ExplanationResponsible for enforcing HIPAA regulations.
#16
What is a common method used for Electronic Data Interchange (EDI) in healthcare billing?
EDI transactions over the internet
ExplanationElectronic exchange of billing data over the internet.
#17
What does the term 'Revenue Integrity' mean in healthcare revenue cycle management?
Preventing revenue leakage and optimizing revenue capture
ExplanationEnsuring revenue optimization and prevention of losses.