Name: Class: Date: - Chapter 01 Overview of Revenue Cycle Management...

Name: Class: Date: Chapter 01 Overview of Revenue Cycle Management Copyright Cengage Learning. Poweredby Cognero.Page 1 1.What is the first step of the life cycle of a payment claim?

• The patient checks in at the front desk.
• Denials and appeals have been closed.
• Coinsurance payments are met.
• Treatment plans have been identified.

ANSWER: a

FEEDBACK: a. Correct. The revenue cycle is the life cycle of a payment claim that begins when the patient checks in at the front desk and ends after all payments or denials and appeals have been made.

• Incorrect. The revenue cycle ends when all payments or denials and appeals

have been made.

• Incorrect. Coinsurance is the percentage the patient pays for covered services

after the deductible has been met and the copay has been paid.

• Incorrect. Bills must accurately describe the treatment or service so that the

claim can be paid appropriately.

POINTS: 1

DIFFICULTY: Easy

REFERENCES: Introduction

QUESTION TYPE: Multiple Choice

HAS VARIABLES: False

LEARNING OBJECTIVES: LO: 1.1 - Identify the steps in the revenue cycle.OTHER: Bloom's: Understand

DATE CREATED: 6/2/2023 1:17 AM

DATE MODIFIED: 6/2/2023 1:20 AM

2.Why is it important that the process of managing billing cycles be performed accurately and on a timely basis?

• to maintain cash flows
• to ensure deductibles have been met
• to enable the organization to become a covered entity
• to prevent Medicare abuse

ANSWER: a

FEEDBACK: a. Correct. Throughout the process of managing billing cycles, cash flow must be maintained to enable health care facilities to deliver quality care to their patients and stay in business.

• Incorrect. The insurance provider, not the provider of the service, will ensure

that deductibles have been met.

• Incorrect. Health care organizations that are required to comply with HIPAA

regulations are known as covered entities (CE), and that definition includes all organizations that electronically transmit any information that is protected under

HIPAA.

• Incorrect. Medicare defines abuse as “practices that directly or indirectly result

in unnecessary costs to Medicare.”

POINTS: 1

DIFFICULTY: Easy

REFERENCES: Introduction

QUESTION TYPE: Multiple Choice

Revenue Cycle for Healthcare, 1e Linda Parks (Test Bank, All Chapters. 100% Original Verified, A+ Grade) 1 / 4

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Chapter 01 Overview of Revenue Cycle Management

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HAS VARIABLES: False

LEARNING OBJECTIVES: LO: 1.1 - Identify the steps in the revenue cycle.OTHER: Bloom's: Analyze

DATE CREATED: 6/2/2023 2:01 AM

DATE MODIFIED: 6/2/2023 2:03 AM

• How does HIPAA apply to the revenue cycle?
• It protects patient information.
• It tracks copays and deductibles for patients.
• It indicates what a patient will owe for services.
• It determines eligibility for Medicare and Medicaid.

ANSWER: a

FEEDBACK: a. Correct. HIPAA applies to the revenue cycle because it protects the transmission of patient information as well as the privacy of the patient’s information as it is shared in the business of reimbursing for services rendered.

• Incorrect. Patients and their insurance companies must be billed for services in

accordance with the terms of their health insurance coverage, deductibles, copays, and coinsurances.

• Incorrect. Coinsurance is the percentage the patient pays for covered services

after the deductible has been met and the copay has been paid.

• Incorrect. Medicare and Medicaid are covered and monitored under

amendments to the Social Security Act.

POINTS: 1

DIFFICULTY: Easy

REFERENCES: HIPAA and the Revenue Cycle

QUESTION TYPE: Multiple Choice

HAS VARIABLES: False

LEARNING OBJECTIVES: LO: 1.2 - Describe the role of HIPAA in the revenue cycle.OTHER: Bloom's: Understand

DATE CREATED: 6/2/2023 2:03 AM

DATE MODIFIED: 6/2/2023 2:06 AM

• What is the role of health care clearinghouses in the revenue cycle?
• to convert nonstandard transactions into standard ones
• to transmit all information protected under HIPAA
• to monitor the impact of privacy rules
• to provide information to lessen imminent danger

ANSWER: a

FEEDBACK: a. Correct. Health care clearinghouses are companies that convert nonstandard transactions into standard transactions and transmit the data to health plans and the reverse process.

• Incorrect. Health care organizations that are required to comply with HIPAA

regulations are known as covered entities (CE), and that definition includes all organizations that electronically transmit any information that is protected under

HIPAA. 2 / 4

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Chapter 01 Overview of Revenue Cycle Management

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• Incorrect. The Privacy Rule covers the use and disclosure of PHI that is

transmitted or maintained by electronic media, such as over the Internet to “the cloud” or stored on computer modems or remote servers.

• Incorrect. Information needed to prevent or lessen imminent danger may be

disclosed to law enforcement if the information is needed to identify or apprehend an escapee or violent criminal.

POINTS: 1

DIFFICULTY: Easy

REFERENCES: HIPAA and the Revenue Cycle

QUESTION TYPE: Multiple Choice

HAS VARIABLES: False

LEARNING OBJECTIVES: 1.2 - Describe the role of HIPAA in the revenue cycle.

OTHER: Bloom's: Understand

DATE CREATED: 6/2/2023 2:06 AM

DATE MODIFIED: 6/2/2023 2:09 AM

• In the revenue cycle system, which group is responsible for billing and receiving payment for health care services in the

normal course of business?

• health care providers
• health care plans
• health care clearinghouses
• health care covered entities

ANSWER: a

FEEDBACK: a. Correct. Health care providers are the people or organizations that furnish, bill, and are paid for health care in the normal course of business.

• Incorrect. Health plans are individual or group health insurance plans that pay

for medical care.

• Incorrect. Health care clearinghouses are companies that convert nonstandard

transactions into standard transactions and transmit the data to health plans and the reverse process.

• Incorrect. Health care organizations that are required to comply with HIPAA

regulations are known as covered entities (CE), and that definition includes all organizations that electronically transmit any information that is protected under

HIPAA.

POINTS: 1

DIFFICULTY: Easy

REFERENCES: HIPAA and the Revenue Cycle

QUESTION TYPE: Multiple Choice

HAS VARIABLES: False

LEARNING OBJECTIVES: LO: 1.2 - Describe the role of HIPAA in the revenue cycle.OTHER: Bloom's: Understand

DATE CREATED: 6/2/2023 2:09 AM

DATE MODIFIED: 6/2/2023 2:11 AM

• What is used to protect how personal health information is transmitted or maintained by electronic media? 3 / 4

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Chapter 01 Overview of Revenue Cycle Management

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• the Privacy Rule
• clearinghouses
• revenue cycle management
• the Security Rule

ANSWER: a

FEEDBACK: a. Correct. The Privacy Rule covers the use and disclosure of PHI that is transmitted or maintained by electronic media, such as over the Internet to “the cloud” or stored on computer modems or remote servers.

• Incorrect. Health care clearinghouses are companies that convert nonstandard

transactions into standard transactions and transmit the data to health plans and the reverse process.

• Incorrect. Revenue cycle management consists of all administrative and clinical

functions that contribute to the capture, management, and collection of patient service revenue.

• Incorrect. The HIPAA Security Rule protects a subset of information covered by

the Privacy Rule.

POINTS: 1

DIFFICULTY: Easy

REFERENCES: HIPAA and the Revenue Cycle

QUESTION TYPE: Multiple Choice

HAS VARIABLES: False

LEARNING OBJECTIVES: LO: 1.3 - Recommend procedures to ensure compliance with HIPAA regulations.OTHER: Bloom's: Understand

DATE CREATED: 6/2/2023 2:11 AM

DATE MODIFIED: 6/2/2023 2:13 AM

• Which rights does the Privacy Rule give to individuals over their PHI?
• the right to direct the transition of an electronic copy to a third party
• the right to high-quality health care
• the right to protection of image in the public health system
• the right to physical well-being

ANSWER: a

FEEDBACK: a. Correct. The Privacy Rule gives individuals rights over their PHI, including the right to examine and obtain copies of their records, to direct a covered entity to transmit an electronic copy to a third party, and the right to request corrections.

• Incorrect. One goal of the Privacy Rule is to allow the flow of health information

needed to provide and promote high-quality health care.

• Incorrect. One goal of the Privacy Rule is to allow the flow of health information

needed to protect the public's health and well-being.

• Incorrect. One goal of the Privacy Rule is to allow the flow of health information

needed to provide and promote high-quality health care that protects the public's well-being.

POINTS: 1

DIFFICULTY: Easy

REFERENCES: HIPAA and the Revenue Cycle

QUESTION TYPE: Multiple Choice

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