AHIMA Revenue Cycle Management Best Practice Questions Solved 100% Correct 4 levels of Visual controls - ✔- Visual indicator - Visual signal - Visual control - Visual guarantee 3 Cost Clarificati ons - ✔Traceability, Variability, Controllability 2 Categories of Traceability - ✔Direct costs and indirect costs 3 types of cost variability - ✔Variable, fixed, mixed 4 models (methods) for the distribution of costs - ✔1) Step -down method 2) Direct method 3) Double -distribution method 4) Simultaneous -equations method 2 standards required in order to implement Activity -Based Costing (ABC) - ✔Standard Cost Profile (SCP) and Standard Treatment Protocols (STP) Calculation of Relative Value Unit - ✔RVU = Total Cost /Greatest Common Denominator (GCD) Calculation for Cost -to-Charge Ratio - ✔CCR = total costs / total charges How does the medical record relate to the revenue cycle? - ✔The medical record contains the documentation required for providers to make educated treatment plans, AND provides coders and billing staff the information they need to ensure proper billing. Describe the flow of the revenue cycle - ✔Series of activities that connects the services rendered by a healthcare provider with the methods by which the provider receives compensation. Identify and Intake Patient --> Perform Services --> Bill for Services --> Collect payment Why is a bill hold important in the revenue cycle? - ✔The waiting period for reconciliation of activiti es vs charges, making corrections, and applying additional coding if necessary. Longer bill holds caused by errors in front -end processing can cause billing delays, reduced payment, or no payment. List revenue cycle functions that can be supported by HI M professionals - ✔Coding, Abstracting, Data validation and quality assurance, coordinating the resolution of potential billing errors, implementing processes for revenue cycle management, and clinical documentation improvement. The traditional role of HI M is ensuring that proper diagnosis and procedure codes are used for billing. What are the performance improvement methodologies that apply to revenue cycle management? - ✔Plan -Do-Check -Act (PDCA), Six Sigma, Lean Methodologies List the 3 steps or co mponents of a financial transaction - ✔Goods or services are provided, a transaction is recorded, and compensation is remitted. List categories of financial accounts - ✔Assets (including inventory and A/R), Liabilities (including A/P, N/P), Equity, Reve nue, Expenses, Reserves Demonstrate the impact of a financial transaction on the accounting equation. - ✔Accounting equation is the theoretical and arithmetic foundation for the recording of transactions. Equity = Assets - Liabilities. Payment receive d for services rendered will increase cash and decrease the A/R, thus leaving the value of Assets unchanged. Explain the difference between charges and revenue - ✔Charges correspond to the services provided to the patient and are accumulated in a patien t account. When the patient is discharged, the charges are posted to increase A/R and increase patient service revenue. Both A/R and PSR are then adjusted (decreased) by the contractual allowance associated with the payer. How does a group purchasing co ntract benefit a provider? - ✔A GPC enables an organization to save money by taking advantage of discounts offered to larger purchasers. How does pay for performance affect reimbursement? - ✔Pay for performance provides incentives for meeting specific o utcomes criteria as well as penalties for failure to achieve benchmarks. What are the 2 methods of third -party reimbursement? - ✔Fee-for-service (FFS) and Capitation List the subcategories of a FFS contract - ✔percent of charges, bundled payments, prospective payment, and hybrids What is a risk to the payer in a FFS contract? - ✔Services reimbursed at agreed -upon amounts may exceed the associated revenue stream from premiums. What is the risk to the provider in an FFS Contract? - ✔1) the cost of providing care will exceed the reimbursement 2) the patient's coverage for certain services has exceeded its limits
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