CHFP STUDY SET - REVENUE CYCLE EXAM QUESTIONS AND
ANSWERS WITH COMPLETE SOLUTIONS VERIFIED
Accounts Receivable Collection Period
number of days in the accounting period divided by accounts receivable turnover; this ratio indicates on
average, how long it takes to collect amounts due
Advance Beneficiary Notice (ABN)
the mandated form required to be given to Medicare beneficiaries related to non-covered outpatient
services; waiver that a provider has a patient sign confirming the patient's understanding that certain
provided services may not be reimbursable under Medicare and therefore are the patient's
responsibility; provider may not collect if this form was not presented and signed. Two copies - original
for provider & copy for patient or representative.
Allowed Amount
maximum amount Medicare will pay in a given area for a covered service
Ambulatory Patient Group (APG), Ambulatory Payment Classification (APC)
institutional outpatient reimbursement system based on the methodology developed by CMS; these are
to outpatient visits/services what MS-DRGs are to inpatient hospital admissions; the payments are based
on categories or groupings of like or similar servies
APR-DRG
, All patient refined DRG is software developed by 3M to identify and classify members into clinically
meaningful categories based on disease(s), disease progression, severity of illness and risk of mortality of
a payors' population
Assignment
agreement in which a patient transfers to a provider the right to receive payment from a third party for
the service the patient has received
Capitation
method under which selected health services are paid for on the basis of a fixed rate per eligible
member without regard to the actual number or nature of services provided to each enrollee; typically
paid per member per month
Charge description master or chargemaster (AKA CDM)
a file that contains a list of chargeable services and associated prices
Hard Cost
Loss of future revenue (of dissatisfied patients; likely precipitated by a negative experience a patient had,
who decides not to return)
Soft Cost
the customer's negative word‐of‐mouth advertising. This may influence others not to use the hospital.
Patient's Path
Pre-treatment/Access, Treatment, Patient Financial Services
Medical necessity
ANSWERS WITH COMPLETE SOLUTIONS VERIFIED
Accounts Receivable Collection Period
number of days in the accounting period divided by accounts receivable turnover; this ratio indicates on
average, how long it takes to collect amounts due
Advance Beneficiary Notice (ABN)
the mandated form required to be given to Medicare beneficiaries related to non-covered outpatient
services; waiver that a provider has a patient sign confirming the patient's understanding that certain
provided services may not be reimbursable under Medicare and therefore are the patient's
responsibility; provider may not collect if this form was not presented and signed. Two copies - original
for provider & copy for patient or representative.
Allowed Amount
maximum amount Medicare will pay in a given area for a covered service
Ambulatory Patient Group (APG), Ambulatory Payment Classification (APC)
institutional outpatient reimbursement system based on the methodology developed by CMS; these are
to outpatient visits/services what MS-DRGs are to inpatient hospital admissions; the payments are based
on categories or groupings of like or similar servies
APR-DRG
, All patient refined DRG is software developed by 3M to identify and classify members into clinically
meaningful categories based on disease(s), disease progression, severity of illness and risk of mortality of
a payors' population
Assignment
agreement in which a patient transfers to a provider the right to receive payment from a third party for
the service the patient has received
Capitation
method under which selected health services are paid for on the basis of a fixed rate per eligible
member without regard to the actual number or nature of services provided to each enrollee; typically
paid per member per month
Charge description master or chargemaster (AKA CDM)
a file that contains a list of chargeable services and associated prices
Hard Cost
Loss of future revenue (of dissatisfied patients; likely precipitated by a negative experience a patient had,
who decides not to return)
Soft Cost
the customer's negative word‐of‐mouth advertising. This may influence others not to use the hospital.
Patient's Path
Pre-treatment/Access, Treatment, Patient Financial Services
Medical necessity
