HFMA SET 1 EXAM QUESTIONS WITH
CORRECT ANSWERS || STUDY GUIDE
Qs || VERIFIED
\.Define Revenue Cycle - Answer- REVENUE CYCLE ----- is the series of events and services
provided prior to, during, and after the course of treatment
\.Departments that contribute to the Revenue Cycle. - Answer- Departments that contribute
to the Revenue Cycle.
1. Access
2. Health information management/ Medical records
3. Case-management
4. Patient Care Services
5. Patient Financial Services
\.What led the creation of revenue management services? - Answer- The emphasis on the
revenue cycle has resulted in the need to organize its components differently and created a new
business unit known as revenue integrity or revenue management services.
\.Benefit of Electronic transactions? - Answer- Electronic transactions."------ transactions are
associated with revenue capture and collection activities. The implementation of electronic data
interchange (EDI) allows actions previously conducted by telephone/ manual methods to be
performed electronically ( improves workflow).
,\.5010 Transaction Set Function? - Answer- 5010 Transaction Set------new transaction
processing system with new transaction standards. These standards will:
a. Offer healthcare providers enhanced information.
b. Require providers to provide payers with additional data to facilitate claim payments.
\.6 Transactions associated with the revenue cycle include: - Answer- 6 Transactions
associated with the revenue cycle include:
a. Claim/Encounter (837-I, 837-P, 837-COB, 837-P COB, NCPD).
b. Remittance (835).
c. Claim Status Inquiry/Response (276/277).
d. Eligibility Inquiry/Response (270/271).
e. Healthcare Services Review (278) Pre-certification and Referrals.
f. Acknowledgment (999)
\.Which of the following would be a hard cost of customer dissatisfaction?
Loss of future revenue Negative word-of-mouth advertising Decisions of future patients to use
another facility Decisions of current patients to use other facilities for future ancillary services -
Answer- loss of future revenue
\.Define hard cost and soft cost. - Answer- 1. Hard Cost -the loss of future revenue
2. Soft Cost- Negative word-of-mouth advertising that may influence others not to use the
hospital.
\.Single greatest reason for an inability to bill and collect accounts receivable in a timely
manner? - Answer- Single greatest reason for an inability to bill and collect accounts
receivable in a timely manner:
Inadequate and incorrect information received from the admitting/patient access department
,\.When certain services are not covered, a Medicare patient should be issued a/an
__________to notify the patient that they may be responsible for payment. - Answer- ABN---
Advance Beneficiary Notice of Non-Coverage (ABN)
\.The COBRA benefit is provided to employees or their family members if they lose coverage
due to a number
of reasons, such as the following: (list 4) - Answer- The COBRA benefit is provided to
employees or their family members if they lose coverage due to a number of reasons, such as
the following:
Loss of employment
Reduction in hours worked
Divorce
Death of the supporting spouse
\.The time required for gathering information has the highest return when the investment is
made _________.
Before the patient's arrival
After discharge
When the first bill comes off
After the account goes to collections - Answer- Before the patient's arrival
, \.What are the 4 things included in claims adjudication? - Answer- Claims adjudication
includes the following:
1.Determination of benefits levels and coverage
2. Coordination of benefits
3.Subrogation of third-party liability claims
4.Generation of appropriate explanation of benefit forms
\.What are the twin goals of financial counseling? - Answer- The twin goals of financial
counseling are:
That the provider understands upfront a patient's ability to pay, and
That the patient understands his or her financial responsibility to the provider.
\.Accounts receivable (A/R) personnel must become key participants in the POS collection
process.
Is this statement true or false? - Answer- False
\.Which of the following is true of deposits?
A deposit should be requested to secure payment when precise charge calculations are not
practical.
Deposit policies should be reviewed and approved by the CFO.
CORRECT ANSWERS || STUDY GUIDE
Qs || VERIFIED
\.Define Revenue Cycle - Answer- REVENUE CYCLE ----- is the series of events and services
provided prior to, during, and after the course of treatment
\.Departments that contribute to the Revenue Cycle. - Answer- Departments that contribute
to the Revenue Cycle.
1. Access
2. Health information management/ Medical records
3. Case-management
4. Patient Care Services
5. Patient Financial Services
\.What led the creation of revenue management services? - Answer- The emphasis on the
revenue cycle has resulted in the need to organize its components differently and created a new
business unit known as revenue integrity or revenue management services.
\.Benefit of Electronic transactions? - Answer- Electronic transactions."------ transactions are
associated with revenue capture and collection activities. The implementation of electronic data
interchange (EDI) allows actions previously conducted by telephone/ manual methods to be
performed electronically ( improves workflow).
,\.5010 Transaction Set Function? - Answer- 5010 Transaction Set------new transaction
processing system with new transaction standards. These standards will:
a. Offer healthcare providers enhanced information.
b. Require providers to provide payers with additional data to facilitate claim payments.
\.6 Transactions associated with the revenue cycle include: - Answer- 6 Transactions
associated with the revenue cycle include:
a. Claim/Encounter (837-I, 837-P, 837-COB, 837-P COB, NCPD).
b. Remittance (835).
c. Claim Status Inquiry/Response (276/277).
d. Eligibility Inquiry/Response (270/271).
e. Healthcare Services Review (278) Pre-certification and Referrals.
f. Acknowledgment (999)
\.Which of the following would be a hard cost of customer dissatisfaction?
Loss of future revenue Negative word-of-mouth advertising Decisions of future patients to use
another facility Decisions of current patients to use other facilities for future ancillary services -
Answer- loss of future revenue
\.Define hard cost and soft cost. - Answer- 1. Hard Cost -the loss of future revenue
2. Soft Cost- Negative word-of-mouth advertising that may influence others not to use the
hospital.
\.Single greatest reason for an inability to bill and collect accounts receivable in a timely
manner? - Answer- Single greatest reason for an inability to bill and collect accounts
receivable in a timely manner:
Inadequate and incorrect information received from the admitting/patient access department
,\.When certain services are not covered, a Medicare patient should be issued a/an
__________to notify the patient that they may be responsible for payment. - Answer- ABN---
Advance Beneficiary Notice of Non-Coverage (ABN)
\.The COBRA benefit is provided to employees or their family members if they lose coverage
due to a number
of reasons, such as the following: (list 4) - Answer- The COBRA benefit is provided to
employees or their family members if they lose coverage due to a number of reasons, such as
the following:
Loss of employment
Reduction in hours worked
Divorce
Death of the supporting spouse
\.The time required for gathering information has the highest return when the investment is
made _________.
Before the patient's arrival
After discharge
When the first bill comes off
After the account goes to collections - Answer- Before the patient's arrival
, \.What are the 4 things included in claims adjudication? - Answer- Claims adjudication
includes the following:
1.Determination of benefits levels and coverage
2. Coordination of benefits
3.Subrogation of third-party liability claims
4.Generation of appropriate explanation of benefit forms
\.What are the twin goals of financial counseling? - Answer- The twin goals of financial
counseling are:
That the provider understands upfront a patient's ability to pay, and
That the patient understands his or her financial responsibility to the provider.
\.Accounts receivable (A/R) personnel must become key participants in the POS collection
process.
Is this statement true or false? - Answer- False
\.Which of the following is true of deposits?
A deposit should be requested to secure payment when precise charge calculations are not
practical.
Deposit policies should be reviewed and approved by the CFO.
