CRCR Section 1 - Revenue Cycle
Introduction
The Revenue Cycle - ANS Includes all of the major processing steps required to process a
patient account from the request for service through closing the account with a zero balance
and purging it from the system.
1.1 Best Practice (Patient Centric) Revenue Cycle Overview (p. 6 of my notes)
* Scheduling and pre-registering
* Encounter generated
* Guarantor information is obtained/updated
* Medical Necessity screening
* Health plan coverage and benefits are verified
* Pre-Authorizations are obtained
* The cost of the scheduled service is identified and calculated
* Calculation of copay, coinsurance, and deductibles - ANS Pre-Service processes
1.1 Best Practice (Patient Centric) Revenue Cycle Overview (p. 6 of my notes)
* Scheduled Patients:
* A final account review is completed prior to the patient's arrival.
* Pre-registration record is activated
* Consents are signed
* Co-payments and/or other agreed upon amounts are collected.
* Positive patient identification is completed, and the patient is given an
armband
* Unscheduled Patients (Walk-ins)
* Comprehensive registration and financial processing is completed
* This process mirrors the work completed for the scheduled patients
prior to service.
* Case Management and discharge planning - ANS Time-of-service processes
1.1 Best Practice (Patient Centric) Revenue Cycle Overview (p. 6 - 7 of my notes)
* Final coding of all services provided
* Preparation and submission of claims
* Payment processing
,* Balance billing and resolution
* Account reaches a zero balance - ANS Post-Service processes
1.1 Best Practice (Patient Centric) Revenue Cycle Overview (p. 7 of my notes)
False - ANS Consents are signed as part of the post-service process (T or F)
1.1 Best Practice (Patient Centric) Revenue Cycle Overview (p. 6 of my notes)
True - ANS Patient service costs are calculated in the pre-service process for scheduled
patients (T or F)
1.1 Best Practice (Patient Centric) Revenue Cycle Overview (p. 6 -7 of my notes)
False - ANS The patient is scheduled and registered for service is a time-of-service activity (T
or F)
1.1 Best Practice (Patient Centric) Revenue Cycle Overview (p. 6 -7 of my notes)
False - ANS The patient account is monitored for payment is a time-of-service activity (T or F)
1.1 Best Practice (Patient Centric) Revenue Cycle Overview (p. 6 -7 of my notes)
False - ANS Case management and discharge planning services are a post-service activity (T
or F)
1.1 Best Practice (Patient Centric) Revenue Cycle Overview (p. 6 -7 of my notes)
False - ANS Sending the bill electronically to the health plan is a time-of-service activity (T or F)
1.1 Best Practice (Patient Centric) Revenue Cycle Overview (p. 6 -7 of my notes)
to improve the way we communicate about healthcare prices. Out of these efforts have come
recommendations for all stakeholders. - ANS HFMA convened stakeholders from across the
healthcare industry to do what?
1.2 Healthcare Dollars & Sense (p. 10 of my notes)
1 ) Patient Financial Communications Best Practices
2) Best Practices for Price Transparency
3) Medical Account Resolution - ANS What are the 3 HFMA Revenue Cycle Initiatives?
1.2 Healthcare Dollars & Sense (p. 10 - 18 of my notes)
,These common-sense best practices bring: consistency, clarity, and transparency to patient
financial communications by outlining steps to help patients understand the cost of services they
receive, their insurance coverage, and their individual responsibility - ANS Patient Financial
Communications Best Practices...
1.2 Healthcare Dollars & Sense (p. 10 of my notes)
During the discharge process - ANS In an emergency medical condition, when should the
financial discussion take place?
1.2 Healthcare Dollars & Sense (p. 10 of my notes)
As early as possible, before a financial obligation is incurred (i.e., before care is provided) -
ANS Excluding emergency medical conditions, best practices stipulate that reasonable attempts
should be made to have the financial discussion when?
1.2 Healthcare Dollars & Sense (p. 10 of my notes)
Annually - ANS According to HFMA's best practices, how often should training on the
organization's financial assistance policies for all staff who engage in patient financial
discussions happen?
1.2 Healthcare Dollars & Sense (p. 14 of my notes)
Health Insurance Marketplace, also known as Health Insurance Exchange - ANS Where
individuals and small businesses can compare and purchase qualified health benefit plans.
1.2 Healthcare Dollars & Sense (p. 15 of my notes)
1. The type of hospital service based on CPT or MS-DRG code.
2. The patient's health plan
3. The patient's benefit plan - ANS In order to provide a patient with information that is
meaningful to them, what factors must be included?
1.2 Healthcare Dollars & Sense (p. 15 of my notes)
Taking the charge for service based on the CPT/HCPCS or MS-DRG code and applying a
hospital's health plan contract terms and the patient's benefit plan to the charges to determine
an accurate patient liability. - ANS What is price transparency?
1.2 Healthcare Dollars & Sense (p. 15 of my notes)
, Association of Credit and Collections Professionals International - ANS HFMA partnered with
ACA and brought together provider organizations, our business partners in the collection
agencies, and patient advocates to form the Medical Debt Task Force.
What is the ACA?
1.2 Healthcare Dollars & Sense (p. 17 of my notes)
To improve both the efficiency of the revenue cycle and the patient experience. - ANS What is
the goal of the Medical Debt Task Force?
1.2 Healthcare Dollars & Sense (p. 17 of my notes)
* Educate patients
* Follow best practices for communication
* Make ALL billing and other communications clear, concise, correct, and
patient-friendly.
* Establish policies and make sure they are followed
* Be consistent in key aspects of account resolution
* Coordinate to avoid duplicate patient contacts
* Exercise good judgement about the best ways to communicate with
patients about bills.
* Start account resolution clock when first statement is sent to the patient.
* Report to credit bureaus when account is resolved
* Track all complaints - ANS The following statements describe best practices established by
the Medical Debt Task Force. Select the True statements.
1.2 Healthcare Dollars & Sense (p. 16 of my notes)
False - ANS Process compliance is a main HFMA Healthcare Dollars & Sense revenue cycle
initiative. (True or False)
1.2 Healthcare Dollars & Sense (p. 9 - 18 of my notes)
Hosptial Consumer Assessment of Healthcare Providers & Systems - ANS HCAHPS
1.3 Patient Experience and Satisfaction (p. 20 of my notes)
HCAHPS initiative - ANS The Center for Medicare and Medicaid Services (CMS)
implementation of the value‐based purchasing program has increasingly highlighted a focus on
core measures, one of which is the?
1.3 Patient Experience and Satisfaction (p. 20 of my notes)
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