AHBC 121 Intro to Revenue Management-
Complete Exam Study Guide 2026/2027
with Verified Answers | Newest Version.
A+
Accounts Receivable Management
assists providers in the collection of appropriate reimbursement for services rendered; includes
functions such as insurance verification/eligibility and preauthorization of services.
accept assignment
provider accepts as payment in full whatever is paid on the claim by the payer (except for any
copayment and/or coinsurance amounts).
Assignment of benefits
the provider receives reimbursement directly from the payer
balance billing
billing beneficiaries for amounts not reimbursed by payers (not including copayments and
coinsurance amounts); this practice is prohibited by state workers compensation plans and
federal government programs.
Chargemaster
computer-generated encounter form that contains a list of procedures, services, supplies, and
revenue codes; chargemaster data are entered in the outpatient hospital facility's patient
accounting system, and charges are automatically posted to the patient's bill (UB-04).
Charge Description Master (CDM)
see chargemaster.
Birthday rule
determines coverage by primary and secondary policies when each parent subscribes to a
different health insurance plan.
case management
, development of patient care plans to coordinate and provide care for complicated cases in a
cost-effective manner.
claims rejection
unpaid claim returned by third-party payers because it fails to meet certain data requirements,
such as missing data (e.g., patient name, policy number); rejected claims can be corrected and
resubmitted for processing.
Claims Denial
unpaid claim returned by third-party payers because of beneficiary identification errors, coding
errors, diagnosis that does not support medical necessity of procedure/service, duplicate
claims, global days of surgery E/M coverage issue, NCCI edits, and other patient coverage issues
(e.g., procedure or service required preauthorization, procedure is not included in patient's
health plan contract, such as cosmetic surgery).
data analytics
tools and systems that are used to analyze clinical and financial data, conduct research, and
evaluate the effectiveness of disease treatments.
Data Analysis
see data analytics.
discharged not final coded (DNFC)
patient claims that are not finalized because of coding delays or incomplete documentation.
day sheet
also called manual daily accounts receivable journal; chronological summary of all transactions
posted to individual patient ledgers/accounts on a specific day.
data mining
extracting and analyzing data to identify patterns, whether predictable or unpredictable.
data warehouse
database that uses reporting interfaces to consolidate multiple databases, allowing reports to
be generated from a single request; data is accumulated from a wide range of sources within an
organization and is used to guide management decisions.
Discharged Not Final Billed (DNFB)
Complete Exam Study Guide 2026/2027
with Verified Answers | Newest Version.
A+
Accounts Receivable Management
assists providers in the collection of appropriate reimbursement for services rendered; includes
functions such as insurance verification/eligibility and preauthorization of services.
accept assignment
provider accepts as payment in full whatever is paid on the claim by the payer (except for any
copayment and/or coinsurance amounts).
Assignment of benefits
the provider receives reimbursement directly from the payer
balance billing
billing beneficiaries for amounts not reimbursed by payers (not including copayments and
coinsurance amounts); this practice is prohibited by state workers compensation plans and
federal government programs.
Chargemaster
computer-generated encounter form that contains a list of procedures, services, supplies, and
revenue codes; chargemaster data are entered in the outpatient hospital facility's patient
accounting system, and charges are automatically posted to the patient's bill (UB-04).
Charge Description Master (CDM)
see chargemaster.
Birthday rule
determines coverage by primary and secondary policies when each parent subscribes to a
different health insurance plan.
case management
, development of patient care plans to coordinate and provide care for complicated cases in a
cost-effective manner.
claims rejection
unpaid claim returned by third-party payers because it fails to meet certain data requirements,
such as missing data (e.g., patient name, policy number); rejected claims can be corrected and
resubmitted for processing.
Claims Denial
unpaid claim returned by third-party payers because of beneficiary identification errors, coding
errors, diagnosis that does not support medical necessity of procedure/service, duplicate
claims, global days of surgery E/M coverage issue, NCCI edits, and other patient coverage issues
(e.g., procedure or service required preauthorization, procedure is not included in patient's
health plan contract, such as cosmetic surgery).
data analytics
tools and systems that are used to analyze clinical and financial data, conduct research, and
evaluate the effectiveness of disease treatments.
Data Analysis
see data analytics.
discharged not final coded (DNFC)
patient claims that are not finalized because of coding delays or incomplete documentation.
day sheet
also called manual daily accounts receivable journal; chronological summary of all transactions
posted to individual patient ledgers/accounts on a specific day.
data mining
extracting and analyzing data to identify patterns, whether predictable or unpredictable.
data warehouse
database that uses reporting interfaces to consolidate multiple databases, allowing reports to
be generated from a single request; data is accumulated from a wide range of sources within an
organization and is used to guide management decisions.
Discharged Not Final Billed (DNFB)
