The Revenue Cycle Quiz

The claim is ready to be billed and scrubbed for billing errors. The SSC associate will apply any edits to the claim or coordinate with the facility if the edit cannot be made by the SSC. Once the edits are completed and the claim is validated, the claim is billed to the responsible payor.

• Billing

• Follow-Up

• In-Audit Phase

• Customer Service

_______ is responsible for prepping, posting, and balancing payments received by the payors. They will also identify and resolve any posting errors made to the account. 

• Cash Services

• Billing

• Denials

• Customer Service

While the patient is at the hospital, a medical record of their stay is maintained. After services are rendered and the patient has been discharged, the medical record is coded into charges by the Health Information Management (HIM) and loaded into the billing system within 72 hours.

• Denials

• Scheduling

• Post-Scheduling

• In-Audit Phase

They reviews claims that deny for things such as medical necessity, max units exceeded, experimental/investigational, coding edits, and inpatient only procedures. They will appeal denied claims before the payor issues payment by making the corrections or submitting the proper documents; known as pre-pay denials.

• Middle Cycle

• Billing

• Follow-Up

• Denials

_______ is a process where the essential elements of a scheduled appointment are verified and obtained. This process includes obtaining authorization for the services, verifying insurance, contacting the patient to complete the registration, and collecting payments such as the estimated amount due, a pre-existing balance or coinsurance. 

• Billing

• Scheduling

• Pre- Arrival

• Revenue Cycle

Before a patient encounter is created for the hospital, the physician will have to place the order. _______ will use this order to schedule the appointment with the patient; thus, creating the account for the patient. 

• Pre-Arrival

• Scheduling

• Denials

• Customer service

Provides business support functions within the revenue cycle on behalf of the hospital.

• The Revenue Cycle

• SSC Fort Smith

• Billing

• Scheduling

__________ is phone based and is responsible for providing prompt and courteous service to the callers. The representative may also assist in finding financial assistance or accepting a payment

• Cash Services

• Scheduling

• Customer Services

• Denials

Everything that happens from the moment a patient account is created until the payment for the services are received.

• Scheduling

• The Academy

• SSC Fort Smith

• Revenue Cycle

They Are responsible for reviewing a claim that continues to show an outstanding balance. During the this process, additional items may need editing before the payor will process the claim for payment, or the payor will state the reason a claim is being rejected or denied.

• Billing

• Follow-up

• The Revenue Cycle

• In-Audit Phase