EXAM STUDY MATERIALS 8/7/2024 11:29 AM
CMAA Module 6 Exam Questions With
Correct Answers
A series of administrative functions that are required to capture and collect payment for services
provided by a health care organization. - answer✔✔Revenue Cycle
sent out on a regular basis, and outstanding balances need to be monitored. Any nonpayment
from the patient requires collection activities. - answer✔✔Patient statements should be
Registering and scheduling - answer✔✔Revenue cycle begins
they have received the final payment for services - answer✔✔Revenue Cycle ends
Collecting precise demographic information, accurate data-entry, verifying accurate coding, and
timely billing all impact the patient experience. Complete and accurate claims promote a healthy
revenue cycle and build patient trust and confidence in the organization. - answer✔✔The patient
experience can be affected throughout a patient's health care journey, including the revenue
cycle. What are some of the actions that impact the patient experience related to billing?
practice management system (PMS) to perform revenue cycle tasks and streamline front office
and back office workflows with automation - answer✔✔Today, most health care organizations
use a
to boost productivity and can help with sustainability and stronger financial performance.
Scheduling appointments, charge capture, coding, billing, generating financial/aging reports,
generating patient statements, and managing the accounts receivable are all examples of how the
PMS is efficiently used. - answer✔✔The practice management system is an efficient way
An efficient way to electronically manage administrative functions, such as scheduling
appointments, integrating patient documentation from electronic health records, coding, billing,
and revenue cycle tasks such as running aging reports and managing the accounts receivable. -
answer✔✔Practice Management System PMS
This step occurs when the patient calls for an appointment. The CMAA will gather patient
information such as demographic and insurance information, determine the type of appointment
needed, and enter the appointment on the provider's schedule. During appointment scheduling,
the patient may be asked to arrive 15 min early to complete new patient registration forms or
update existing information. - answer✔✔Phases of Revenue Cycle Registration and Scheduling
, EXAM STUDY MATERIALS 8/7/2024 11:29 AM
The patient completes the registration (demographic and insurance), HIPAA, and other
compliance and policy forms, along with medical history information. The CMAA will scan or
copy the patient's insurance card and cross-check the information completed on the registration
form to the data entered in the practice management system (PMS) during the registration and
scheduling step, then changes the patient's status to checked in. - answer✔✔Phases of Revenue
Cycle PT Check in
Also known as utilization review (UR), this is the process of ensuring the patient has the
appropriate referral, precertification, predetermination, or preauthorization as needed. This
process supports the revenue cycle by ensuring the payer, provider, and patient have met any
required conditions and understand how the service will be reimbursed and what the patient
responsibility amount will be. Not all services or procedures will require a UR. The CMAA must
be familiar with rules and guidelines for third-party payers, as they will vary.
When in doubt, always verify by contacting the payer to determine if UR is necessary for the
procedure or service. Documentation of UR is important for scheduling and claims purposes. For
example, once a preauthorization is obtained, document the authorization number, expiration
date, and any specified details in the patient's health record.
Prior to the procedure or service being p - answer✔✔Phases of Revenue Cycle Utilitzation
Management Review
Finding out if the service is covered by the patient's plan. - answer✔✔precertification
Determining the payer's reimbursement amount for the service. - answer✔✔predetermination
Finding out if the payer considers a service medically necessary based on the patient's specific
condition. - answer✔✔preauthorization
The health care encounter and documentation are part of the clinical aspect of the revenue cycle.
The provider will review the patient's medical history and reason for the encounter, perform a
physical exam as indicated, order any diagnostic or lab tests, and perform an assessment and
develop a treatment plan. The CMAA would verify coverage for certain procedures, obtain the
preauthorization, and document it in the PMS or medical record. - answer✔✔Phases of Revenue
Cycle Health Care Encounter and Documentation
Once the encounter and documentation are complete, charge capture or charge entry is
performed. This is the process of capturing each procedure code and corresponding diagnosis
code for the encounter in preparation for billing. Depending on organizational policy, the
provider may select the codes (CPT®, HCPCS, and ICD-10-CM) for the encounter, and the
CMAA may verify the codes for completeness and import or enter them into the billing
application. It is important to ensure that the diagnosis code(s) supports the medical necessity of
the procedural codes. - answer✔✔Phases of Revenue Cycle Charge Capture and Coding
When the encounter with the provider has ended, the patient wil proceed to check-out. If a return
appointment needs to be scheduled, ask the patient what day/time works best for their schedule.
, EXAM STUDY MATERIALS 8/7/2024 11:29 AM
Collect the copay if it was not collected during the check-in process and any coinsurance or
deductible amounts that may have incurred during the encounter and have been verified with the
insurance company. Some organizations use real-time adjudication to support this task.
The patient will be presented with an after-visit summary (AVS), which includes demographic
information on file, the reason for the encounter, vital signs, tests/labs ordered, the conditions
managed at the time of the encounter, and related patient instructions or educational materials.
Most importantly, the patient should feel they received top-quality care from check-in to check-
out. The CMAA should thank the patient for allowing the health care organizat -
answer✔✔Phases of Revenue Cycle PT Check out
Prior to billing claims to the third-party payer, the CMAA should verify patient demographic and
insurance information, as well as review the CPT, HCPCS, and ICD-10-CM codes to ensure that
codes are appropriately linked to demonstrate medical necessity. For example, the CPT code for
an ankle x-ray should not be linked to the ICD-10-CM code for bronchitis. Make the appropriate
corrections per the organization's policies and procedures. Query the provider as necessary.
Taking a moment to review the claim information will reduce the potential for denied claims. -
answer✔✔Phases of Revenue Cycle Billing
Adjudication is the process by which the insurance carrier reviews the benefits and coverage and
then either processes or denies the claim. The adjudication process will also identify patient
responsibility associated with deductibles, copays, or coinsurance. Notification will be sent to the
health care organization via remittance advice. - answer✔✔Phases of Revenue Cycle Payer
Adjudication
The remittance advice is the notice of payment to the health care organization, explains any
adjustments made to the payment, and provides patient responsibility for any deductible, copay,
or coinsurance amounts. The CMAA may be tasked with reviewing the remittance advice and
comparing it to the patient account to ensure the proper payments and adjustments were posted
correctly by the automated system or by posting manually. Reviewing and comparing the
remittance advice to the patient account will ensure proper billing to the patient and correct
reimbursement to the organization. - answer✔✔Phases of Revenue Cycle Receiving and Posting
Reimbursement
During the payer adjudication process, if claims contain errors or are not supported by the
insurance plan benefits or coverage requirements, or meet the payer requirements for medical
necessity, they will be denied. For any denied claims, the CMAA will contact the payer
following their policy and procedures for correcting or appealing a claim. Some payers require
that appeals be filed electronically; others request a paper form with documentation to support
medical necessity. Each payer has its own requirements and deadlines to file an appeal. When an
incorrect payment is made to the health care organization, the CMAA will need to contact the
payer for assistance. - answer✔✔Phases of Revenue Cycle Appeals/Claims Corrections
Collecting fixed copays and outstanding balances at the time of patient check-in/out is strongly
recommended as it increases the efficiency of patient collections. Proper training on payment
