HCAD 750 P2 Exam Questions With Verified
Answers.
Revenue cycle - answeris the process that begins when a patient comes into the healthcare
system and includes those activities that have to occur in order for a provider of the care to bill at
the end of the patient's service encounter
The heal...
Revenue cycle - answer✔is the process that begins when a patient comes into the healthcare
system and includes those activities that have to occur in order for a provider of the care to bill at
the end of the patient's service encounter
The healthcare revenue cycle encompasses - answer✔people, tools, methodologies, and
techniques that medical institutions use to manage their patients' financial status
Revenue management lifecycle - answer✔is a complex process that involves balancing people,
processes, technology, and the environment in which the processes take place
revenue management life-cycle can be broken down into 3 phases - answer✔the front-end,
middle, and back end
Front end of the revenue cycle includes - answer✔patient access functions such as scheduling of
the patient for services, registration of the patient, prior or preauthorization for services,
insurance verification, service estimates, and financial counseling
middle process of the revenue cycle includes - answer✔case management, capture of charges for
the services rendered, and coding for those services based on clinical documentation
back end of the revenue cycle is typically viewed as - answer✔the business office or patient
financial service process and includes claims processing and payment posting, follow up,
customer service, collections of unpaid bills, and denial management
insurance verification - answer✔is a vital component of the prearrival process for scheduled
patients; it entails validating that the patient is a member of the insurance plan given and is
covered for the scheduled service date
preauthorization is also referred to as ___ and is the requirement that a - answer✔prior approval,
authorization, precertification, or predetermination; healthcare provider obtain permission from
the health insurer prior to predefined services being provided to the patients
financial counselors - answer✔are staff dedicated to helping patients and physicians determine
sources of reimbursement for healthcare services
charity care - answer✔defined as healthcare services that have been or will be provided but are
never expected to result in cash inflows
point of service collection - answer✔is defined as the collection of the portion of the bill that is
likely the responsibility of the patient prior to the provision of service
medical necessity - answer✔a determination that a services is reasonable and necessary for the
related diagnosis or treatment of illness or injury
national coverage determinations - answer✔medicares national coverage policies are known as
local coverage determinations - answer✔local fiscal intermediary policies are known as
These policies define the specific international classification of diseases diagnosis codes that
support medical necessity for many services provided: - answer✔national coverage
determinations and local coverage determinations
steerage - answer✔is when an insurer provides financial incentive or discounted rates to a
facility to obtain a flow of patients it would not otherwise receive
case management - answer✔defined as a collaborative process of assessment, planning,
facilitation, care coordination, evaluation, and advocacy for options and services to meet an
individuals and family's comprehensive health needs through communication and available
resources to promote quality cost effective outcomes
utilization management - answer✔is the evaluation of the medical necessity, appropriateness,
and efficiency of the use of healthcare services, procedures, and facilities under the provisions of
the applicable health benefits plan; sometimes known as utilization review
utilization review staff - answer✔is responsible for the day to day provisions of the hospitals
utilization plan as required by the medicare conditions of participation
charge capture - answer✔is a method of recording services and supplies or items delivered to the
patient and directing them to be billed on a claim form. It is the process of documenting, posting,
and reconciling the charges for services rendered to patients.
claims scrubber software - answer✔designed to detect errors that would result in payer denials
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