Rev Cycle 3 Flashcards
The process of creating the pre=registration record ensures
Ability to pursue extraordinary collection activities
Early and productive communication with a third-party payer
Accurate billing
That access staff will have the compete and valid information needed to finalize any remaining pre-access activities
Accurate billing
Once the EMTALA requirements are satisfied
Third-party payer information should be collected from the patient and the payer should be notified of the ED visit
The patient then assumes full liability for services unless a third-party is notified or the patient applies for financial assistance with the first 48 hours
The remaining registration processing is initiated at the bedside or in a registration area
An initial registration records is completed so that the proper coding can be initiated
The remaining registration processing is initiated at the bedside or in a registration area
This directive was developed to promote and ensure healthcare quality and value and also to protect consumers and workers in the healthcare system. This directive is called
Payer quality monitoring
Medicare patient and staff safety standards
Joint Commission for Accreditation of Healthcare Organizations (JCAHO) safety
Patient bill of rights
Patient bill of rights
scheduled inpatient represents an opportunity for the provider to do which of the following?
Refer the patient to another location with the health system
Comply with EMTALA (Emergency Medical Treatment and Labor Act) requirements before service
Complete registration and insurance approval before service
Register the patient after he or she is placed in a bed on that service unit.
Complete registration and insurance approval before service
The first and most critical step in registering a patient, whether scheduled or unscheduled, is
Having the patient initial the HIPAA privacy statement
Verifying insurance to activate the patient medical record
Verifying the patient’s identification
Check the schedule for treatment availability
Verifying the patient’s identification
The legal authority to request and analyze provider clam documentation to ensure that IPPS services were reasonable and necessary is given to
Recovery Audit Contractors (RAC)
The Office of the U.S. Inspector General (OIG)
All health plans
State insurance commissioners
The Office of the U.S. Inspector General (OIG)
An advantage of a pre-registration program is
The opportunity to reduce processing times at the time of service
The ability to eliminate no-show appointments
The opportunity to reduce the corporate compliances failures within the registration process
The marketing value of such a program
The opportunity to reduce the corporate compliances failures within the registration process
Claims with dates of service received later than one calendar year beyond the date of service, will be
Denied by Medicare
The provider’s responsibility but can be deemed charity care
Fully paid with interest
The full responsibility of the patient.
Denied by Medicare
This concept encompasses all activities required to send a request for payment to a third-party health plan for payment of benefits
Third-party invoicing
Account resolution
Claims processing
Billing
Claims processing
The ACO investment model will test the use of pre-paid shared savings to
Raise quality ratings in designated hospitals.
Encourage new ACOs to form in rural and underserved areas
Attract physicians to participate in the ACO payment system
Invest in treatment protocols that reduce costs to Medicare
Encourage new ACOs to form in rural and underserved areas
Chapter 13 Bankruptcy, debtor rehabilitation, is a court proceeding
That establishes a payment priority order to creditors’ claims
That classifies the debtor as eligible for government financial assistance for housing, medical treatment and food as debts are paid
That creates a clear court-supervised payment accountability plan going forward
That reorganizes a debtor’s holdings and instructs creditors to look to the debtor’s future earnings for payment
That reorganizes a debtor’s holdings and instructs creditors to look to the debtor’s future earnings for payment
HFMA’s patient financial communication best practices specify that patients should be told about the types of services provided and
A satisfaction survey regarding clinical service providers
The price of service to their covering health plan
The service providers that typically participate in the service, e.g., radiologists, pathologists, etc.
An expiration of why a specific service is not provided
The service providers that typically participate in the service, e.g., radiologists, pathologists, etc.
The important Message from Medicare provides beneficiaries information concerning their
Understanding of billing issues and the deductibles and/or co-insurance due for the current visit
Right to refuse to use lifetime reserve days for the current stay
Right to appeal a discharge decision if the patient disagrees with the plan
Obligation to reimburse the hospital for any services not covered by the Medicare program
Right to appeal a discharge decision if the patient disagrees with the plan
All of the following are potential causes of credit balances EXCEPT
Duplicate payments
Primary and secondary payers both paying as primary
Inaccurate upfront collections based on incorrect liability estimates
A patient’s choice to build up a credit against future medical bills
A patient’s choice to build up a credit against future medical bills
Medicare Part B has an annual deductible, and the beneficiary is responsible for
A co-insurance payment for all Part B covered services
Physicians office fees
Tests outside of an inpatient setting
Prescriptions
A co-insurance payment for all Part B covered services
