Business Office Assessment Flashcards

1
Q

Private Payor accounts can be collected in advance with the exception of which private payer (s)?

A

Medicare CoInsurance from Private

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2
Q

Which Payor Type can we collect coinsurance in advance?

A

HMO/Medicare Adv Health plans

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3
Q

When should the resident be notified of their co-pay amount due?

A

upon admission (within 48hrs and weekly billing with follow up

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4
Q

Per our collections policy the_____th day of the month is considered past due on a continuing monthly private payer account?

A

10th

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5
Q

The 1st collection letter should go out to current in-house residents by the ______ of the month?

A

20th

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6
Q

All collection activity; phone calls, collection letters, any correspondence from the resident or responsible party should be clearly documented where?

A

PCC Collection Module - Resident

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7
Q

Best practices if the BOM has sent out the statement with the due date for payment and collection calls collection letters have been sent out the _________ would get involved?

A

ED

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8
Q

When should Medicare coinsurance from insurance be moved to Medicare coinsurance from private if not originally booked as such?

A

Upon receipt for of the insurance EOB be notifying the facility that they will not pay coinsurance

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9
Q

What email address do you use in order to request an asset search?

A

Assetsearch@ensignservices.net

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10
Q

A resident who exhaust all 100 days in a skilled nursing facility but is still receiving skilled care services must submit what type of claim to Medicare monthly?

A

Benefit exhaust clamp

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11
Q

A resident becomes eligible for Medicare part A benefits on 12/1/16 and was in the hospital as inpatient from 11/ 25/16 to 11/30/16 can be covered under Medicare part A for their admission on 12/3/16? Yes or no?

A

No resident must have a three day stay once they are eligible for part a benefits

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12
Q

Occurrence span code WHAT is used when part of a residence day is considered provide reliable?

A

77

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13
Q

Occurrence code WHAT is used on the UB04 to identify when a resident skilled level of care is ended along with the date active care ended

A

22

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14
Q

Medicare part a no pay claims are billed with WHAT type of bill and condition called WHAT

A

210, 21

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15
Q

Value code 80 is
Value code 81 is
Value code 82 is
Value code 09 is

A
  • Total number covered days
  • Total number non-covered days
  • Total number coinsurance days
  • Medicare coinsurance amount
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16
Q

When checking claims in DDE; status code_____Means returned to provider

A

TB

17
Q

What function key in DDE do you hit to find the reason a claim has been returned to provider or RTP?

A

F1

18
Q

What criteria must be met in order for a resident to regenerate a new 100 day benefit?

A

60 consecutive days of wellness that are not at a skilled level of care