,Solution manual for Revenue Cycle for Healthcare,
1st Edition Linda J. Parks
Notes
1- The file is chapter after chapter.
2- We have shown you few pages sample.
3- The file contains all Appendix and Excel
sheet if it exists.
4- We have all what you need, we make
update at every time. There are many new
editions waiting you.
5- If you think you purchased the wrong file
You can contact us at every time, we can
replace it with true one.
Our email:
, Solution and Answer GuideParks, Revenue Cycle for Healthcare, 1e, 9780357625514; Chapter 1: Overview of Revenue Cycle Management
Solution and Answer Guide
PARKS, REVENUE CYCLE FOR HEALTHCARE, 1E, 9780357625514; CHAPTER 1: OVERVIEW OF REVENUE CYCLE MANAGEMENT
TABLE OF CONTENTS
Check Your Understanding: Remittance Advice ...................................................................................1
Enrichment activity: Interview............................................................................................................1
Enrichment activity: Careers ...............................................................................................................1
End of Chapter Review .......................................................................................................................2
CHECK YOUR UNDERSTANDING: REMITTANCE ADVICE
Review the remittance advice in Figure 1-7 to familiarize yourself with its organization and legend.
Identify the most likely reason why patient Lynch was not charged for coinsurance.
Answer: The billed amount is the same as the allowed amount agreed to by the payer, therefore there is
no coinsurance due. Suggestion: This question can be used by the instructor to open a discussion about
remittance advice and explanation of benefits.
ENRICHMENT ACTIVITY: INTERVIEW
Interview an insurance specialist whose task is to monitor claims status within the billing department of
a health care facility. Ask these questions:
• What is their procedure for monitoring the claims process?
• What AI software do they use to track the status of claims?
• Can they identify the number of claims that are returned because of errors?
Answer: Answers will vary.
ENRICHMENT ACTIVITY: CAREERS
Go to https://ahima.org/careermap and explore the emerging careers in revenue cycle management
that are available to you. Choose one and explain what the job is, what technology you anticipate
working with, what education level you need to perform that job, and why that job appeals to you.
Answer: Answers will vary based on individual student interest.
© 2024 Cengage Learning, Inc. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly 1
accessible website, in whole or in part.
, Solution and Answer GuideParks, Revenue Cycle for Healthcare, 1e, 9780357625514; Chapter 1: Overview of Revenue Cycle Management
END OF CHAPTER REVIEW
1. Explain the goals of the claims adjudication process performed by the payer.
Answer: Verify the claim is not a duplicate submission, verify the service provided is a covered benefit, verify
deductibles, copays and coinsurances as outlined on the patient’s plan.
2. What is the significance of a clean claim? In your answer, forecast the ramifications of errors.
Answer: A clean claim is one that is free of errors, both demographic, coding and completeness of claim
documentation. Claims returned because of errors or omissions slow the reimbursement to the provider and
thus impact the financial viability of the facility.
3. Differentiate deductible, copay, and coinsurance. Why is it important for the provider and the patient to know
the difference?
Answer: The deductible is an amount for which the patient is financially responsible before the insurance
policy provides coverage. Coinsurance is the percentage the patient pays for covered services after the
deductible has been met and the copay has been paid. The copay is the specific dollar amount the patient is
required to pay to a heath care provider for each visit or medical service received, as stated in the insurance
policy.
4. Summarize the significance of a managed care contract to the way health care is delivered today.
Answer: Contracts are legally binding and describe the obligations of the providers and payers in providing
healthcare services to patients who are insurance plan members/beneficiaries. This contract includes how the
claims are to be submitted, medical necessity determination, any contract exclusions, per diem arrangements,
predefined fee schedules, and capitation. The provider agrees to accept, in full, the payment established in the
contract. A fee schedule is included that lists what the insurance company will pay for each provided service or
supply. The contract, in turn, gives the payer access to confidential patient records.
5. Map the steps in the revenue cycle, explaining which department/personnel are responsible for each step.
Answer: Answers may be a graph, table or narrative but should demonstrate the student’s understanding of
each step
6. Choose any step in the revenue cycle and recommend a procedure to ensure compliance with HIPAA Privacy
and Security Rules.
Answer: Answers will vary.
7. Assess how the use of technology makes the revenue cycle more efficient.
Answer: Answers will vary depending on which technology the student addresses or if they compare all
possible uses of technology.
8. Compare how the various Security Rule safeguards protect ePHI.
Answer: Answers will vary but should include discussions of all three safeguards: administrative, technical and
physical.
© 2024 Cengage Learning, Inc. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly 2
accessible website, in whole or in part.
, Solution and Answer GuideParks, Revenue Cycle for Healthcare, 1e, 9780357625514; Chapter 2: Reimbursement Processes and Tools
Solution and Answer Guide
PARKS, REVENUE CYCLE FOR HEALTHCARE, 1E, 9780357625514; CHAPTER 2: REIMBURSEMENT PROCESSES AND TOOLS
TABLE OF CONTENTS
Check your understanding: MCOs .......................................................................................................1
Check your understanding: Utilization Review and Case Management ................................................2
Enrichment Activity: Revenue Cycle as Part of Health Care Finance .....................................................3
Enrichment Activity: Managed Care Plans ...........................................................................................3
Enrichment Activity: PAR and nonPAR physicians ...............................................................................3
Enrichment Activity: Effects of the ACA ..............................................................................................4
Enrichment Activity: Understanding CAC ............................................................................................4
End of Chapter Review .......................................................................................................................4
CHECK YOUR UNDERSTANDING: MCOS
1. Which of the following provides a list of services and the amount that an insurance company will pay
for each service?
a. Capitation
b. Fee schedule
c. Point of service plan
Answer: Fee schedule
2. Which of the following are MCOs? Select all that apply.
a. HMO
b. POS
c. PPO
d. PCP
Answer: HMO, PPO
© 2024 Cengage Learning, Inc. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly 1
accessible website, in whole or in part.
, Solution and Answer GuideParks, Revenue Cycle for Healthcare, 1e, 9780357625514; Chapter 2: Reimbursement Processes and Tools
3. Summarize the most common requirements of PPO, HMO, and POS systems.
Answer: PPO: patients are encouraged to use in-network providers; HMO: patients must use in-network
providers and have a PCP; POS: patients are encouraged to use in-network providers, they must have a
PCP and a referral to a specialist when needed.
CHECK YOUR UNDERSTANDING: UTILIZATION REVIEW AND CASE
MANAGEMENT
1. Which type of care requires collaboration across roles, including patients, caregivers, and social
workers?
a. Utilization review
b. Case management
c. Preadmission review
Answer: Case management
2. Explain the purpose of each of the following types of review.
a. Prospective
b. Concurrent
c. Retrospective
Answer:
Prospective: Preadmission certification of medical necessity and pre-authorization
Concurrent: Review of treatment/care during hospitalization
Retrospective: Includes discharge planning for appropriate services post discharge or an audit of the
documentation of the medical record after the patient has been discharged.
3. Which of the following are tasks that hospital case managers may perform? Select all that apply.
a. Communicate with insurance to gain authorization for planned care
b. Advocate for patients and their families
c. Question interventions contrary to evidence-based best practices
d. Audit documentation after the patient is discharged
Answer: Advocate for patients and their families, and Question interventions contrary to evidence-
based best practices.
© 2024 Cengage Learning, Inc. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly 2
accessible website, in whole or in part.
, Solution and Answer GuideParks, Revenue Cycle for Healthcare, 1e, 9780357625514; Chapter 2: Reimbursement Processes and Tools
ENRICHMENT ACTIVITY: REVENUE CYCLE AS PART OF HEALTH CARE
FINANCE
1. What does it mean if a bill is “dropped”?
Answer: Bills reach the accounting office and the charges are posted to accounts receivable.
2. Accounts receivable refers to which of the following?
a. Claims for payment held by a business for goods or services for which payment has not yet been
received.
b. Claims for payment held by a business for goods or services for which payment has been
received and recorded.
c. A bill identified as DNFB.
d. The average number of days between the discharge date and the receipt of payment for
services rendered
Answer: Claims for payment held by a business for goods or services for which payment has not yet
been received.
3. Define a DNFB bill.
Answer: Discharged Not final Billed is the time frame during which a bill is awaiting late charges,
diagnosis or procedure codes or other required information.
ENRICHMENT ACTIVITY: MANAGED CARE PLANS
Instructions: Go to ncqa.org and locate the report cards.
Step 1: Compare all the 5-star and 4.5-star rated health care plans on the report cards. How many of
these managed care plans are HMOs or PPOs? Commercial or Medicare/Medicaid MCOs?
Step 2: Randomly choose five of these organizations’ highly rated plans and open the link to view the
details of their ratings. What do these five plans have in common that validates their high ratings?
Step 3: Present your findings.
Answer: Answers will vary. The presentations can be used for further discussion of managed care plans.
ENRICHMENT ACTIVITY: PAR AND NONPAR PHYSICIANS
1. Determine the nonPAR allowed charge and limiting charge when the fee schedule for CPT code
99213 is $100.
Answer: Allowed charge is $95 (100 x 0.05 = 5; 100 – 5 = 95); Limiting charge is $109.25 (95 x 1.15 =
109.25)
© 2024 Cengage Learning, Inc. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly 3
accessible website, in whole or in part.
, Solution and Answer GuideParks, Revenue Cycle for Healthcare, 1e, 9780357625514; Chapter 2: Reimbursement Processes and Tools
2. Determine the amount Medicare is responsible for and the patient’s coinsurance amount for code
99213 when the fee schedule is $100 for a participating physician.
Answer: Reimbursement amount is $80 (80% of 100; patient coinsurance amount is $20 (20% of 100)].
ENRICHMENT ACTIVITY: EFFECTS OF THE ACA
Research the Affordable Care Act and present a report on the impact of this act on health care delivery
and financing.
Answer: Responses may vary but should include discussion of ACO’s; instructor may have more specific
directions for the assignment.
ENRICHMENT ACTIVITY: UNDERSTANDING CAC
1. Interview a coder or a coding supervisor at a local hospital or medical center that uses computer-
assisted coding. Ask them the degree of difficulty involved in learning to work with the software
tool, if they see an improvement in time savings and coding accuracy, and at least two other
questions of your own. Report your findings to your class. Be prepared to answer questions.
2. Do an online search for CAC vendors. Choose one. Review their website looking for the elements of
their product related to efficiency, accuracy, ability to interface with existing coding or EHR systems,
and production of management reports. Report your findings to your class. Be prepared to answer
questions.
Answer: Responses will vary as instructors adjust or change any element of these presentation
requirements to meet their needs.
END OF CHAPTER REVIEW
1. Discuss your opinion of the most advantageous characteristic of managed care organizations.
Answer: Answers will vary but may include coordination of care, integration of financing and quality of
healthcare delivery, or management of costs and outcomes.
2. Analyze the similarities of methods used by government payers and commercial payers to reimburse for
health care services.
Answer: Answers will vary; both offer managed care plan options, both monitor quality of care, both attempt
to limit costs.
3. Evaluate the connection between the use of encoders, CAC, software, and reimbursement for services
rendered.
Answer: Answers should describe the evolution of logic algorithms in code selection and development of
natural language processing that assists the selection of appropriate diagnosis and procedures codes that
identify services to be reimbursed.
© 2024 Cengage Learning, Inc. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly 4
accessible website, in whole or in part.
, Solution and Answer GuideParks, Revenue Cycle for Healthcare, 1e, 9780357625514; Chapter 2: Reimbursement Processes and Tools
4. Forecast how the use of AI software will enhance the ability of medical coders but will never replace them.
Answer: Answers will vary but should include the need for human intervention to verify appropriate code
selection or that it frees them to manage the revenue cycle more efficiently.
© 2024 Cengage Learning, Inc. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly 5
accessible website, in whole or in part.
, Solution and Answer GuideParks, Revenue Cycle for Healthcare, 1e, 9780357625514; Chapter 3: Health Care Finance Information as a Strategic Resource
Solution and Answer Guide
PARKS, REVENUE CYCLE FOR HEALTHCARE, 1E, 9780357625514; CHAPTER 3: HEALTH CARE FINANCE INFORMATION AS A
STRATEGIC RESOURCE
TABLE OF CONTENTS
Check Your Understanding: Communicating Financial Matters ............................................................1
Check Your Understanding: Rules and Pricing .....................................................................................1
Enrichment Activity: Expenses ............................................................................................................2
Enrichment Activity: Reporting a Budget Variance ..............................................................................2
Enrichment Activity: Explanation of Benefits ......................................................................................3
Enrichment Activity: Pricing ...............................................................................................................3
End of Chapter Review .......................................................................................................................3
CHECK YOUR UNDERSTANDING: COMMUNICATING FINANCIAL MATTERS
1. Which of the following would a non-Medicare patient receive?
a. ABN
b. EOB
c. MAC
d. Summary Notice
Answer: MAC Medicare Administrative Contractors
2. Which of the following are included in an EOB? Select all that apply.
a. Service description
b. Date of payment
c. Amount paid by the insurer
d. Remark codes
e. Bank information for payer and payee
Answer: Service description; Amount paid by the insurer; Remark codes
CHECK YOUR UNDERSTANDING: RULES AND PRICING
1. Which of the following must be included in the machine-readable file
© 2024 Cengage Learning, Inc. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly 1
accessible website, in whole or in part.
1st Edition Linda J. Parks
Notes
1- The file is chapter after chapter.
2- We have shown you few pages sample.
3- The file contains all Appendix and Excel
sheet if it exists.
4- We have all what you need, we make
update at every time. There are many new
editions waiting you.
5- If you think you purchased the wrong file
You can contact us at every time, we can
replace it with true one.
Our email:
, Solution and Answer GuideParks, Revenue Cycle for Healthcare, 1e, 9780357625514; Chapter 1: Overview of Revenue Cycle Management
Solution and Answer Guide
PARKS, REVENUE CYCLE FOR HEALTHCARE, 1E, 9780357625514; CHAPTER 1: OVERVIEW OF REVENUE CYCLE MANAGEMENT
TABLE OF CONTENTS
Check Your Understanding: Remittance Advice ...................................................................................1
Enrichment activity: Interview............................................................................................................1
Enrichment activity: Careers ...............................................................................................................1
End of Chapter Review .......................................................................................................................2
CHECK YOUR UNDERSTANDING: REMITTANCE ADVICE
Review the remittance advice in Figure 1-7 to familiarize yourself with its organization and legend.
Identify the most likely reason why patient Lynch was not charged for coinsurance.
Answer: The billed amount is the same as the allowed amount agreed to by the payer, therefore there is
no coinsurance due. Suggestion: This question can be used by the instructor to open a discussion about
remittance advice and explanation of benefits.
ENRICHMENT ACTIVITY: INTERVIEW
Interview an insurance specialist whose task is to monitor claims status within the billing department of
a health care facility. Ask these questions:
• What is their procedure for monitoring the claims process?
• What AI software do they use to track the status of claims?
• Can they identify the number of claims that are returned because of errors?
Answer: Answers will vary.
ENRICHMENT ACTIVITY: CAREERS
Go to https://ahima.org/careermap and explore the emerging careers in revenue cycle management
that are available to you. Choose one and explain what the job is, what technology you anticipate
working with, what education level you need to perform that job, and why that job appeals to you.
Answer: Answers will vary based on individual student interest.
© 2024 Cengage Learning, Inc. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly 1
accessible website, in whole or in part.
, Solution and Answer GuideParks, Revenue Cycle for Healthcare, 1e, 9780357625514; Chapter 1: Overview of Revenue Cycle Management
END OF CHAPTER REVIEW
1. Explain the goals of the claims adjudication process performed by the payer.
Answer: Verify the claim is not a duplicate submission, verify the service provided is a covered benefit, verify
deductibles, copays and coinsurances as outlined on the patient’s plan.
2. What is the significance of a clean claim? In your answer, forecast the ramifications of errors.
Answer: A clean claim is one that is free of errors, both demographic, coding and completeness of claim
documentation. Claims returned because of errors or omissions slow the reimbursement to the provider and
thus impact the financial viability of the facility.
3. Differentiate deductible, copay, and coinsurance. Why is it important for the provider and the patient to know
the difference?
Answer: The deductible is an amount for which the patient is financially responsible before the insurance
policy provides coverage. Coinsurance is the percentage the patient pays for covered services after the
deductible has been met and the copay has been paid. The copay is the specific dollar amount the patient is
required to pay to a heath care provider for each visit or medical service received, as stated in the insurance
policy.
4. Summarize the significance of a managed care contract to the way health care is delivered today.
Answer: Contracts are legally binding and describe the obligations of the providers and payers in providing
healthcare services to patients who are insurance plan members/beneficiaries. This contract includes how the
claims are to be submitted, medical necessity determination, any contract exclusions, per diem arrangements,
predefined fee schedules, and capitation. The provider agrees to accept, in full, the payment established in the
contract. A fee schedule is included that lists what the insurance company will pay for each provided service or
supply. The contract, in turn, gives the payer access to confidential patient records.
5. Map the steps in the revenue cycle, explaining which department/personnel are responsible for each step.
Answer: Answers may be a graph, table or narrative but should demonstrate the student’s understanding of
each step
6. Choose any step in the revenue cycle and recommend a procedure to ensure compliance with HIPAA Privacy
and Security Rules.
Answer: Answers will vary.
7. Assess how the use of technology makes the revenue cycle more efficient.
Answer: Answers will vary depending on which technology the student addresses or if they compare all
possible uses of technology.
8. Compare how the various Security Rule safeguards protect ePHI.
Answer: Answers will vary but should include discussions of all three safeguards: administrative, technical and
physical.
© 2024 Cengage Learning, Inc. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly 2
accessible website, in whole or in part.
, Solution and Answer GuideParks, Revenue Cycle for Healthcare, 1e, 9780357625514; Chapter 2: Reimbursement Processes and Tools
Solution and Answer Guide
PARKS, REVENUE CYCLE FOR HEALTHCARE, 1E, 9780357625514; CHAPTER 2: REIMBURSEMENT PROCESSES AND TOOLS
TABLE OF CONTENTS
Check your understanding: MCOs .......................................................................................................1
Check your understanding: Utilization Review and Case Management ................................................2
Enrichment Activity: Revenue Cycle as Part of Health Care Finance .....................................................3
Enrichment Activity: Managed Care Plans ...........................................................................................3
Enrichment Activity: PAR and nonPAR physicians ...............................................................................3
Enrichment Activity: Effects of the ACA ..............................................................................................4
Enrichment Activity: Understanding CAC ............................................................................................4
End of Chapter Review .......................................................................................................................4
CHECK YOUR UNDERSTANDING: MCOS
1. Which of the following provides a list of services and the amount that an insurance company will pay
for each service?
a. Capitation
b. Fee schedule
c. Point of service plan
Answer: Fee schedule
2. Which of the following are MCOs? Select all that apply.
a. HMO
b. POS
c. PPO
d. PCP
Answer: HMO, PPO
© 2024 Cengage Learning, Inc. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly 1
accessible website, in whole or in part.
, Solution and Answer GuideParks, Revenue Cycle for Healthcare, 1e, 9780357625514; Chapter 2: Reimbursement Processes and Tools
3. Summarize the most common requirements of PPO, HMO, and POS systems.
Answer: PPO: patients are encouraged to use in-network providers; HMO: patients must use in-network
providers and have a PCP; POS: patients are encouraged to use in-network providers, they must have a
PCP and a referral to a specialist when needed.
CHECK YOUR UNDERSTANDING: UTILIZATION REVIEW AND CASE
MANAGEMENT
1. Which type of care requires collaboration across roles, including patients, caregivers, and social
workers?
a. Utilization review
b. Case management
c. Preadmission review
Answer: Case management
2. Explain the purpose of each of the following types of review.
a. Prospective
b. Concurrent
c. Retrospective
Answer:
Prospective: Preadmission certification of medical necessity and pre-authorization
Concurrent: Review of treatment/care during hospitalization
Retrospective: Includes discharge planning for appropriate services post discharge or an audit of the
documentation of the medical record after the patient has been discharged.
3. Which of the following are tasks that hospital case managers may perform? Select all that apply.
a. Communicate with insurance to gain authorization for planned care
b. Advocate for patients and their families
c. Question interventions contrary to evidence-based best practices
d. Audit documentation after the patient is discharged
Answer: Advocate for patients and their families, and Question interventions contrary to evidence-
based best practices.
© 2024 Cengage Learning, Inc. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly 2
accessible website, in whole or in part.
, Solution and Answer GuideParks, Revenue Cycle for Healthcare, 1e, 9780357625514; Chapter 2: Reimbursement Processes and Tools
ENRICHMENT ACTIVITY: REVENUE CYCLE AS PART OF HEALTH CARE
FINANCE
1. What does it mean if a bill is “dropped”?
Answer: Bills reach the accounting office and the charges are posted to accounts receivable.
2. Accounts receivable refers to which of the following?
a. Claims for payment held by a business for goods or services for which payment has not yet been
received.
b. Claims for payment held by a business for goods or services for which payment has been
received and recorded.
c. A bill identified as DNFB.
d. The average number of days between the discharge date and the receipt of payment for
services rendered
Answer: Claims for payment held by a business for goods or services for which payment has not yet
been received.
3. Define a DNFB bill.
Answer: Discharged Not final Billed is the time frame during which a bill is awaiting late charges,
diagnosis or procedure codes or other required information.
ENRICHMENT ACTIVITY: MANAGED CARE PLANS
Instructions: Go to ncqa.org and locate the report cards.
Step 1: Compare all the 5-star and 4.5-star rated health care plans on the report cards. How many of
these managed care plans are HMOs or PPOs? Commercial or Medicare/Medicaid MCOs?
Step 2: Randomly choose five of these organizations’ highly rated plans and open the link to view the
details of their ratings. What do these five plans have in common that validates their high ratings?
Step 3: Present your findings.
Answer: Answers will vary. The presentations can be used for further discussion of managed care plans.
ENRICHMENT ACTIVITY: PAR AND NONPAR PHYSICIANS
1. Determine the nonPAR allowed charge and limiting charge when the fee schedule for CPT code
99213 is $100.
Answer: Allowed charge is $95 (100 x 0.05 = 5; 100 – 5 = 95); Limiting charge is $109.25 (95 x 1.15 =
109.25)
© 2024 Cengage Learning, Inc. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly 3
accessible website, in whole or in part.
, Solution and Answer GuideParks, Revenue Cycle for Healthcare, 1e, 9780357625514; Chapter 2: Reimbursement Processes and Tools
2. Determine the amount Medicare is responsible for and the patient’s coinsurance amount for code
99213 when the fee schedule is $100 for a participating physician.
Answer: Reimbursement amount is $80 (80% of 100; patient coinsurance amount is $20 (20% of 100)].
ENRICHMENT ACTIVITY: EFFECTS OF THE ACA
Research the Affordable Care Act and present a report on the impact of this act on health care delivery
and financing.
Answer: Responses may vary but should include discussion of ACO’s; instructor may have more specific
directions for the assignment.
ENRICHMENT ACTIVITY: UNDERSTANDING CAC
1. Interview a coder or a coding supervisor at a local hospital or medical center that uses computer-
assisted coding. Ask them the degree of difficulty involved in learning to work with the software
tool, if they see an improvement in time savings and coding accuracy, and at least two other
questions of your own. Report your findings to your class. Be prepared to answer questions.
2. Do an online search for CAC vendors. Choose one. Review their website looking for the elements of
their product related to efficiency, accuracy, ability to interface with existing coding or EHR systems,
and production of management reports. Report your findings to your class. Be prepared to answer
questions.
Answer: Responses will vary as instructors adjust or change any element of these presentation
requirements to meet their needs.
END OF CHAPTER REVIEW
1. Discuss your opinion of the most advantageous characteristic of managed care organizations.
Answer: Answers will vary but may include coordination of care, integration of financing and quality of
healthcare delivery, or management of costs and outcomes.
2. Analyze the similarities of methods used by government payers and commercial payers to reimburse for
health care services.
Answer: Answers will vary; both offer managed care plan options, both monitor quality of care, both attempt
to limit costs.
3. Evaluate the connection between the use of encoders, CAC, software, and reimbursement for services
rendered.
Answer: Answers should describe the evolution of logic algorithms in code selection and development of
natural language processing that assists the selection of appropriate diagnosis and procedures codes that
identify services to be reimbursed.
© 2024 Cengage Learning, Inc. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly 4
accessible website, in whole or in part.
, Solution and Answer GuideParks, Revenue Cycle for Healthcare, 1e, 9780357625514; Chapter 2: Reimbursement Processes and Tools
4. Forecast how the use of AI software will enhance the ability of medical coders but will never replace them.
Answer: Answers will vary but should include the need for human intervention to verify appropriate code
selection or that it frees them to manage the revenue cycle more efficiently.
© 2024 Cengage Learning, Inc. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly 5
accessible website, in whole or in part.
, Solution and Answer GuideParks, Revenue Cycle for Healthcare, 1e, 9780357625514; Chapter 3: Health Care Finance Information as a Strategic Resource
Solution and Answer Guide
PARKS, REVENUE CYCLE FOR HEALTHCARE, 1E, 9780357625514; CHAPTER 3: HEALTH CARE FINANCE INFORMATION AS A
STRATEGIC RESOURCE
TABLE OF CONTENTS
Check Your Understanding: Communicating Financial Matters ............................................................1
Check Your Understanding: Rules and Pricing .....................................................................................1
Enrichment Activity: Expenses ............................................................................................................2
Enrichment Activity: Reporting a Budget Variance ..............................................................................2
Enrichment Activity: Explanation of Benefits ......................................................................................3
Enrichment Activity: Pricing ...............................................................................................................3
End of Chapter Review .......................................................................................................................3
CHECK YOUR UNDERSTANDING: COMMUNICATING FINANCIAL MATTERS
1. Which of the following would a non-Medicare patient receive?
a. ABN
b. EOB
c. MAC
d. Summary Notice
Answer: MAC Medicare Administrative Contractors
2. Which of the following are included in an EOB? Select all that apply.
a. Service description
b. Date of payment
c. Amount paid by the insurer
d. Remark codes
e. Bank information for payer and payee
Answer: Service description; Amount paid by the insurer; Remark codes
CHECK YOUR UNDERSTANDING: RULES AND PRICING
1. Which of the following must be included in the machine-readable file
© 2024 Cengage Learning, Inc. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly 1
accessible website, in whole or in part.
