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AHIMA Revenue Cycle Management Best Practices - Quiz With Complete Solutions
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AHIMA Revenue Cycle Management Best Practices - Quiz With Complete Solutions...
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AHIMA Revenue Cycle Management Best Practices - QuizWith Complete Solutions
Administration What are its roles in the revenue cycle? ANSWER Strategic goals
Operational efficiency and effectiveness
Finance What is its role in the revenue cycle? ANSWER Cash flow
Managed Care/ Payer Services What is its role in the revenue cycle? ANSWER Contract
management
Material breach issues affecting reimbursement (claims projects)
In the revenue cycle, what is the role of Patient Access? - ANSWER - Data Integrity and
quality assurance
- Demographic and financial data
- Insurance verification
- Precertification
In the revenue cycle, what is the role of Clinical/Ancillary services (incl physicians)? -
ANSWER - Clear, concise documentation of services
- Documentation and recordings of charges
In the revenue cycle, what is the role of Health Information Management? - ANSWER -
Coding
- Abstracting
Data Validation and Quality Assurance
, What are the responsibilities of Patient Accounting within revenue cycle? - ANSWER -
Charge Compilation
Billing
Collections
What are the responsibilities of the Patient Intake team, Front-End? - ANSWER -
Documenting the reason for visit
Documenting and verifying, patient identifying data
Documenting and verifying, patient financial data (insurance and guarantor)
Precertification/Authorization
Determine which patients will need financial aid to cover their care
MRI patient tracking number assignment, including MR number
Clinical-service tracking codes, if applicable
Case Management Department - ANSWER Also known as Utilization Management dept.
Responsible to ensure that all managed care patients meet the specific payers
utilization management medical-necessity criteria.
What are the essential routine responsibilities of the revenue cycle staff? - ANSWER -
Key performance indicator (KPI) review
Conduct investigations of processes that are not meeting benchmarks
Monitor denials and clean-claim rates
Initiate performance improvement processes when necessary
Monitor development and implementation of revenue cycle-related processes
What are key strategic activities of the revenue cycle team? - ANSWER - Establish
benchmarks for KPIs
Identify trends of financial data and make recommendations to administration
- Predict how regulatory change, such as the adoption of ICD-10-CM/PCS, will impact
the revenue cycle
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