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RHIA Domain 4 Exam | Questions And Answers Latest {} A+ Graded | 100% Verified
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RHIA Domain 4 Exam | Questions And Answers Latest {} A+ Graded | 100% Verified
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RHIA Domain 4 Exam | Questions And Answers Latest {2024- 2025} A+ Graded | 100%Verified
What are the 3 parts to the revenue cycle process? - Front end middle back end
Claim - Statement of services submitted by a healthcare provider to a third party provider
Premium - Pre-established amount paid by the policy holder for insurance coverage
Insurance verification - The process of checking the patients insurance coverage and benefits before
dating of service to insurance payment for services
Preauthorization - A utilization management process used by some health insurance companies in the
US to determine if they will cover a prescribed procedure, service, or medication
Financial counselors - Staff dedicated to helping patients/physicians determine sources of
reimbursement for healthcare services
Point of service collection - The collection of the portion of the bill that is likely the responsibility of the
patient before the provision of service
Charge description master - Electronic file that represents a master list of all services, supplies, devices,
and medications charged for inpatient or outpatient services
Accounts receivable AR days - Records of the payments owed by the organization by outside entities
Clean claims - A completed insurance claim form that contains all the required information so that it can
be processed and paid promptly
Denials - When a bill has been returned unpaid for any of several reasons
, Bill hold period - The period during which an account will be held from billing so charges can be entered
the patient is discharged
Facility charge - Allows the capture of an E/M charge that represents those resources not included with
the CPT code for the clinic environment (Evaluation and management E/M coding is the use of CPT
codes from the range 99202-99499 to represent services provided by a physician or other qualified
healthcare professional. These medical codes apply to visits and services that involve evaluating and
managing patient health)
Medical necessity - The likelihood that a proposed healthcare service will have a reasonable beneficial
effect on the patients physical condition and quality of life at a specific point in his or her illness or
lifetime
Haldol - Drug administered for behavior/mental conditions
National coverage determination - The United States nationwide determination of whether Medicare
will pay for an item of service
Local coverage determination - Decisions made by a Medicare administrative contractor (MAC) whether
to cover a particular item or service in a MAC's jurisdiction (region) by sections 1862(a)(1)(A) of the
social security act
Administrative service only contracts - An agreement between an employer and an insurance
organization to administer the employers self insurance health plan
Children's health insurance program - Covers uninsured children up to age 19 from low income families
who are otherwise ineligible for Medicaid
Tricare - Healthcare program for active duty members of the military and other qualified family
members
Champva - Health programs for dependents and survivors of permanently and totally disabled veterans
survivors of veterans who died from service related conditions, and survivors of military personnel who
died in the line of duty
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