CRCR - Certified Revenue Cycle Representative Program Charge Capture and Coding Questions and Answers — Questions and Answers
Question 1: A hospital's Charge Description Master (CDM) is a critical component of the revenue cycle. Which of the following is the PRIMARY function of the CDM?
- To list all billable items, services, and their corresponding charges for the facility. (Correct answer)
- To track the productivity of clinical staff based on services rendered.
- To serve as the primary medical record for all patient encounters.
- To negotiate reimbursement rates with commercial insurance payers.
Correct answer: To list all billable items, services, and their corresponding charges for the facility.
The Charge Description Master (CDM), or chargemaster, is a comprehensive list of all billable items and services that a hospital provides to patients. Each entry typically includes a description of the service, a charge code, the price, and associated CPT/HCPCS codes, making it the foundational tool for generating patient bills.
Question 2: A patient receives a routine blood draw (phlebotomy) and a complex series of lab tests in a hospital outpatient setting. Which two code sets would MOST likely be used to capture the services and diagnoses for billing?
- ICD-10-CM and CPT (Correct answer)
- HCPCS Level II and ICD-10-PCS
- CPT and ICD-10-PCS
- DSM-5 and HCPCS Level II
Correct answer: ICD-10-CM and CPT
ICD-10-CM codes are used to report diagnoses. CPT (Current Procedural Terminology) codes are used to report medical, surgical, and diagnostic procedures and services, such as a phlebotomy and lab tests, performed by healthcare professionals. HCPCS Level II codes are typically for supplies and services not included in CPT, and ICD-10-PCS is used for inpatient hospital procedures.
Question 3: A revenue cycle representative is reviewing a daily report that compares clinical documentation in the EHR with the charges posted to patient accounts. Several instances are found where a documented procedure was not charged. This process is known as:
- Code auditing
- Denial management
- Charge reconciliation (Correct answer)
- Utilization review
Correct answer: Charge reconciliation
Charge reconciliation is the process of comparing clinical documentation and records against the charges posted to a patient's account to ensure that all services rendered have been captured and billed accurately. This helps prevent revenue loss from missed charges.
Question 4: Which of the following scenarios would necessitate the use of a HCPCS Level II code instead of a CPT code?
- A physician performing an annual physical exam.
- A surgeon performing an appendectomy.
- Billing for durable medical equipment (DME), such as a wheelchair. (Correct answer)
- A radiologist interpreting a chest X-ray.
Correct answer: Billing for durable medical equipment (DME), such as a wheelchair.
HCPCS Level II codes are used to identify products, supplies, and services not included in the CPT code set. This includes items like ambulance services, durable medical equipment (DME), prosthetics, and certain drugs. Physician services like exams, surgeries, and interpretations are billed with CPT codes.
Question 5: During a departmental audit, it was discovered that a specific surgical supply was consistently being used during a procedure but was not being documented on the charge sheet. What is the MOST likely negative outcome of this error?
- Increased patient satisfaction due to lower bills.
- Revenue leakage for the healthcare facility. (Correct answer)
- A compliance violation with the Joint Commission.
- Faster claim processing times.
Correct answer: Revenue leakage for the healthcare facility.
Failing to capture charges for all services and supplies provided results in revenue leakage. The hospital incurs the cost of the supply but does not receive reimbursement, leading to a direct financial loss. While patients may have lower bills, the primary impact on the facility is negative.
Question 6: The process of translating a physician's documentation of a patient encounter into standardized codes for billing is known as:
- Charge entry
- Adjudication
- Medical coding (Correct answer)
- Pre-authorization
Correct answer: Medical coding
Medical coding is the act of translating healthcare diagnoses, procedures, medical services, and equipment into universal alphanumeric codes. This is a critical step that happens after the service is documented and is essential for creating a claim to be sent to the payer.
