Primary Functions and Responsibilities of Patient Access Flashcards by Roxie Bradshaw

EMATALA

Emergency Medical Treatment and Labor Act

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PSDA

Patient Self Determination Act

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HIPPA

Health Insurance Portability and Accountability Act

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Goals for re-engineering Patient Access consists of

Good customer service
train admitting personnel to become salespeople of patient care
Ensure admitting staff is well educated and can answers questions accurately
Identify mechanisms to decrease wait times
Pre-register patients whenever possible
make the process a positive and painless experience for the patient, guarantor, and or family.

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Primary Functions and Responsibilities of Patient Access

Scheduling
Preregistration/preadmission testing
Precertification/preauthorization
Inpatient admitting and outpatient registration
Insurance verification
Financial counseling

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70-90% are scheduled admissions within 24 hours of the service date

True or False

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During the the process of Preregistration and Preadmission testing what is gathered during this process

Patient demographics name address date of birth, social security number
financial information
socioeconomic information

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Complaints should decrease the implementation of preregistration program because

Financial planning and counseling can be done in advance of the service
Patients are familiarized with the admission process.
special needs can be identified and accommodated.
patients are more prepared and less anxious.
admissions time is reduced.

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PAT

Preadmission Testing

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What is PAT?

prescreening of patients in advance of surgical or invasive procedures to determine if hospitalization or surgical suitability is necessary

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The key success to pre-registration is the insurance verification True or False

True

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Preregistration or preauthorization

This process not only helps determine financial risk, but also delivers an opportunity to develop a rapport with the patient and/or guarantor prior to treatment.

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Patient Access is responsible for timely,courteous and accurate registration or admission of patients true or false.

True

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The registrar does not make the decision to admit a patient this comes from ?

The admitting physician and the hospital administrator and or administration on call

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Registrars responsibilities include

Offering guest services
Applying a permanent patient indentification process for future record storage
initiating the permanent patient medical record for the stay
creating he patient account for the treatment/condition
assuring the accuracy of the patient account record
collecting basic data (demographic,clinical information,financial information,socioeconomics, etc.
collect valuables
verify insurance

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What are some questions are asked when verifying insurance?

Is precert/preauthorization required
DO you need a second surigical opinion
Are benefits available for the diagnosis?
What is the deductible amount and has any portion of it been met?
What is the coinsurance amount and how much remains?
Is there an out-of-pocket limit and ifso, how much?
What is the address to submit claims>
What is the name of the adjuster,
Do they accept TPA?
What is the daily room and board charge allowance?
Is there preexisting condition?

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Financial Counseling is part of Patient Access now

Obtain and verify demographic detail of the patient’
Obtain basic financial information for the responsible party
Establish the ability to pay
Explain the hospital collection policy to the patient or responsible party

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Calculate the ALOS

Average Length of Stay

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Financial Counseling also include notify patients of his/her responsibility financially
establish payment arrangements
complete all preadmission paperwork. True or False

True

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Name the Five Collection Points

Preadmission
Admission
Inhouse
Discharge
After Discharge

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Deposit Collection description

this is the amount of money a patient is responsible for an estimated portion of their bill not covered by insurance.

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Deposit Collection does the following

increase hospital cash collections
decrease amount due at discharge
overall accounts receivables
financial risks and bad debt

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What disadvantages in the deposit collection process

creating a public relations issue between hospital and doctor or patient and hospital or patient and doctor.

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Affiliated Health Services

24 hour access to registered nurse or other qualified non physician practitioner (NPP)
Telephone Triage available in the community
Health information and response to inquiries
referrals for physicians and/or services
customer services and/or satisfaction feedback
registration for in-house or hospital sponsored medical education programs
compliance monitoring

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NPP

non physician practitioner

Physician Direct Services

``` Community Referral Assistance Staff Specialty referral services Primary Care Physician (PCP) staff outbound call services Marketing for the staff physician ```

Case Management/Utilization Review

``` reduces unnecessary admissions manages the length of stay ensure appropriate level of care liaison with primary and specialty physicians liaison with insurance carrier obtain approvals when clinically necessary for precertification/preauthorization advise patient of discharge assist with appeals or denials ```

utilization Review

PCP

Primary care physician

History of chief complaint is not gathered during a preregistration or preadmission? True or False

True

What is the term for patient screening before surgical or invasive procedures to determine hospitalization and or/surgical suitability called?

PAT -Preadmission Testing

Freeing up staff time for training on new technology and regulations part of patient access? True or False

False

When is insurance verification typically done?

During precertification and admitting/registration

What information is calculated to estimate patient responsibility during hospital stay?

ALOS for the diagnosis Average per day by type of service Admitting physician estimated length of stay the hospital flat rate procedures/Drg/contractual payer allowance the daily room charge by type

``` These are the five collection point Preadmission Admission Inhouse Discharge After Discharge True or False ```

True

During which collection points is a patient most likely to pay?

before or at time of admission

``` +cash collections -amount at discharge -overall accounts receivables -financial risks and bad debt +possibility for public relations issues are these outcomes of a deposit collection program correct? true or false ```

True

Marketing for staff physicians are not part of the affiliated health services? True or False

True is not

Physician direct services work directly with physicians so they can deliver professional medical care and opinions? True or False

True

What are some of the critical task performed by the Case Management and Utilization Review team?

Reduce unnecessary admissions Manage approved length of stay ensure level of care serve as liaison between primary and specialty physician obtain approvals when clinically necessary advise patient of discharge assists with appeals and denials

Acute inpatient

patient experiencing acute illness or trauma

ancillary services

are services other than routine room and board charges are incidental to the hospital stay

Observation

usually does not exceed 24 hours no more than 48 hours

If a physician classifies an admission as an emergency the hospital is obligated to admit the patient. True or False

True

CERT

Comprehensive Error Rate Testing

MUE

medically unlike edit

ABN

Advance Beneficiary Notice

Outpatient

treatment received in a clinic or dispensary by someone who is not hospitalized

Long term care

chronically ill patients

Skilled Nursing Facility

a person must be hospitalized for at least 3 days not counting day of discharge

Hospice care

terminally ill

respite care

a person needing a break from taking care of a loved one or sick child

custodial care

personal care for personal needs

Home health care

preventative supportive rehabilitative or therapeutic at home care

Office

done in office

Office visits are done on which form?

1500 form

Consent is patients permission to render services. Signatures providing general consent for treatment are obtained during the admitting/registration process.

True

General consents cover?

routine laboratory testing diagnostic imaging, radiology,ct scan, mri medical treatment

``` special consent forms consists of the following HIV Positive testing major/minor surgery anesthesia nonsurgical/procedures with more than a slight risk or risk of charge in body structure cobalt or radiation therapy electroshock or psychiatric treatment experimental procedures treatment for drug/alcohol disorders ```

True

Actual or expressed consent

means you agree

Implied consent in fact

means you did not agree or agree/silence

implied consent by law

person is unconscious

Informed consent

patient has made a decision for treatment

A person who is intoxicated or unconscious or declarred mentally incompetent by the courts is prevented from consenting to services ? True or False

True

Emancipation

means not covered by parental control

covered under Emancipation

Is must be 18-21 must not be financial supported by parents Father or gave birth to a child

Medical Records

must not be crossed out twice but once with a line drawn through it and the person initial who made the error

Medical Records personnel who are authorized would be the treating and or attending physician a physician extender/Physician assistant, nurse practitioner a registered nurse a student who accredited health profession program(under supervision f his/her clinical instructor True or False

True

Verbal Orders has to be discreet and must be accepted by a physician extender, nurse practitioner or registered nurse? T or F

TRUE

These are the things via telephone orders

``` need to be verbatim for orders the date and time order received the name of ordering physician the name of patient and his/her status the full name of designated staff member documenting the order ```

Advance Beneficiary of Notice of noncoverage

this is used when Medicare will not cover services of an item

HICN

Health Insurance Claim Number

ABN should not be given when in doubt that medicare may not cover? True or False

True

ABN should not be given in an emergency room situation until patient is stablized? True or False

True

MSP

Medicare Secondary Payer

MSP is gathered for what reason

for Coordination of Benefits

IEQ

Initial Enrollment Questionnaire

IEQ

comes 3 months before patient is entitled to Medicare ask about any other insurance coverage to Medicare

MSP questionnaire help determine if medicare is primary or secondary true or false

True

Common Working File

CWF contains medicare patient eligibility and utilzation date it stores information like entitlement to medicare A&B Date of Birth Date of Death Part A and B deductible information Benefit periods and days remaining in the other periods

ABN form must be on file for how many years?

There are three types of Triggering Events with the ABN?

Initiation-at the beginning of treatment Reduction-during treatment Termination-discontinuation of treatment

Do we accept electronic ABN's?

Yes

ALO formula

#of pat days/number of discharges=ALOS

Midnight Census

Previous Midnight Census-Discharges+Admissions+/-Status Changes=Midnight Census

Average Daily Census

ADC is the average of number of inpatients in hospital for a specific time total patient days/#of days=average daily census

Percentage of Occupancy

Census/#of beds available =% of Occupancy

A woman is the primary caregiver for her husband, who has MS the patient needs an alternate caregiver while his wife recovers from an injury.

Respite

A patient is assigned a bed while being monitored for what appears to be a slight head concussion

observation

a patient being seen at a clinic for wound care related to a burn.

Outpatient

A patient is no longer acutely ill, but is weakened following a stroke and needs continuous care to regain strength and function.

SNF

A man need daily antibiotic infusions is confined to his home

Home Health care

A patient is terminally ill and is receiving palliative care

Hospice

If an physician classifies an admission as an emergency the hospital can still refuse the admission

False

Should a correction be required to a medical record and authorized person should draw a single line through the error and initial it and continue the note

True

An emancipated minor is able to give his/her consent to receive treatment

True

In the ER failure of a patient who is aware of what is happening to object treatment is implied by law true or false

FALSE

A single general consent document is signed to cover all procedures and services being informed in any 24 hour period

False

CMS indicated that instances would be rare that a patient would remain in observation for more than 24 hours

False

To qualify for SNF coverage, Medicare requires a person to be hospitalized at least 3 consecutive days not including day of discharge. True or False

True

Which of the following clinical and medical personnel authorized to make entries in patients medical record

Treating and attending physician a Physician extender,physician assistant and nurse practitioner licensed register nurse financial counselor a student from accredited health professional under supervision of clinical instructor

The ABN must be signed and faxed to Medicare within 24 hours True or False

False

Until 2010 medicare was the primary payer for nearly all medicare covered services True or False

False

Telephone orders from referring physicians may be edited by individuals authorized to receive orders for clarity? True or False

True