1 | Page
Chapter 4: Revenue Cycle Management
Questions and Answers 2026 Latest Update
Which means that the patient and/or insured has authorized the
payor to reimburse the provider directly? Ans: Assignment of
benefits
Providers who do not accept assignment of Medicare benefits do
not receive information included on the ______________, which is
sent to the patient. Ans: Medical Summary Notice
The transmission of claims data to payers or clearinghouses is
called claims Ans: submission
A patient received services on April 5, totaling $1,000. He paid a
$90 coinsurance at the time services were rendered. (The payer
required the patient to pay a 20% coinsurance of the reasonable
charge at the time services were provided). The physician accepted
assignment, and the insurance company established the
reasonable charge as $450. On July 1, the provider received $360
from the insurance company. On August 1, the patient received a
check from the insurance company in the amount of $450. The
overpayment was ____________, and the ____________ must
reimburse the insurance company. Ans: $450, patient
A series of fixed-length records submitted to payers to bill for
health care services is an electronic Ans: flat file format
Which is considered a covered entity? Ans: Private-sector payers
that process electronic claims
© 2025 All rights reserved
, 2 | Page
A claim that is rejected because of an error or omission is
considered a(n) Ans: open claim
The chargemaster is a(n) Ans: computer-generated list used by
facilities, which contains procedures, services, supplies, revenue
codes, and charges
Which supporting documentation is associated with submission of
an insurance claim? Ans: Claims attachment
Which is a group health insurance policy provision that prevents
multiple payers from reimbursement benefits covered by other
policies? Ans: Coordination of benefits
The sorting of claims upon submission to collect and verify
information about the patient and provider is called claims Ans:
processing
Which of the following steps would occur first? Ans: Health
insurance specialist completes electronic or paper-based claim
Comparing the claim to payer edits and the patient's health plan
benefits is part of claims Ans: adjudication
Which describes any procedure or service reported on a claim that
is not included on the payer's master benefit list? Ans:
Noncovered benefit or exclusion
Which is an abstract of all recent claims filed on each patient, used
by the payer to determine whether the patient is receiving
concurrent care for the same condition by more than one
provider? Ans: Common data file
© 2025 All rights reserved
Chapter 4: Revenue Cycle Management
Questions and Answers 2026 Latest Update
Which means that the patient and/or insured has authorized the
payor to reimburse the provider directly? Ans: Assignment of
benefits
Providers who do not accept assignment of Medicare benefits do
not receive information included on the ______________, which is
sent to the patient. Ans: Medical Summary Notice
The transmission of claims data to payers or clearinghouses is
called claims Ans: submission
A patient received services on April 5, totaling $1,000. He paid a
$90 coinsurance at the time services were rendered. (The payer
required the patient to pay a 20% coinsurance of the reasonable
charge at the time services were provided). The physician accepted
assignment, and the insurance company established the
reasonable charge as $450. On July 1, the provider received $360
from the insurance company. On August 1, the patient received a
check from the insurance company in the amount of $450. The
overpayment was ____________, and the ____________ must
reimburse the insurance company. Ans: $450, patient
A series of fixed-length records submitted to payers to bill for
health care services is an electronic Ans: flat file format
Which is considered a covered entity? Ans: Private-sector payers
that process electronic claims
© 2025 All rights reserved
, 2 | Page
A claim that is rejected because of an error or omission is
considered a(n) Ans: open claim
The chargemaster is a(n) Ans: computer-generated list used by
facilities, which contains procedures, services, supplies, revenue
codes, and charges
Which supporting documentation is associated with submission of
an insurance claim? Ans: Claims attachment
Which is a group health insurance policy provision that prevents
multiple payers from reimbursement benefits covered by other
policies? Ans: Coordination of benefits
The sorting of claims upon submission to collect and verify
information about the patient and provider is called claims Ans:
processing
Which of the following steps would occur first? Ans: Health
insurance specialist completes electronic or paper-based claim
Comparing the claim to payer edits and the patient's health plan
benefits is part of claims Ans: adjudication
Which describes any procedure or service reported on a claim that
is not included on the payer's master benefit list? Ans:
Noncovered benefit or exclusion
Which is an abstract of all recent claims filed on each patient, used
by the payer to determine whether the patient is receiving
concurrent care for the same condition by more than one
provider? Ans: Common data file
© 2025 All rights reserved
