Question

multiple select question

select all that apply

which of the following questions must be asked during step 2 (establish financial responsibility) of the revenue cycle?

what are the billing rules of the plan?
what services are covered under the plan?
what is the patient responsible for paying?
what services are not covered under the plan?
what is the time frame in which claims must be submitted?

Explanation:

Define Step 2 of the revenue cycle

Using the Medical Billing Revenue Cycle knowledge point, Step 2 is "Establish Financial Responsibility." This step occurs before the patient encounter to determine who is responsible for paying for the services.

Analyze the key questions for Step 2

To establish financial responsibility, the billing specialist must verify insurance coverage and determine patient cost-sharing. This involves answering:

• What are the billing rules of the plan?
• What services are covered under the plan?
• What is the patient responsible for paying?
• What services are not covered under the plan?

Evaluate the options

• "What are the billing rules of the plan?": Yes, necessary to establish how to bill.
• "What services are covered under the plan?": Yes, determines coverage.
• "What is the patient responsible for paying?": Yes, determines patient financial share.
• "What services are not covered under the plan?": Yes, identifies non-covered services.
• "What is the time frame in which claims must be submitted?": No, this is part of claim preparation and submission (later steps in the cycle).

Answer:

• What are the billing rules of the plan? (Correct answer)
• What services are covered under the plan? (Correct answer)
• What is the patient responsible for paying? (Correct answer)
• What services are not covered under the plan? (Correct answer)
• What is the time frame in which claims must be submitted?