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
The importance of medical records being maintained by HIM is that the patient records
Are the primary source for clinical data required for reimbursement by health plans and liability payers
Are the strongest evidence and defense in the event of a Medicare audit
Are evidence used in assessing the quality of care
Are the evidence cited in quality review
Are the primary source for clinical data required for reimbursement by health plans and liability payers
A decision on whether a patient should be admitted as an inpatient or become an outpatient observation patient requires medical judgments based on all of the following EXCEPT
The patient’s home care coverage
Current medical needs
The likelihood of an adverse event occurring to the patient
The patient’s medical history
The patient’s home care coverage
Medicare has established guidelines called the Local Coverage Determinations (LCD) and National Coverage Determinations (NCD) that establish
Provider and physician reimbursement for specific diagnoses and tests
Prospective Medicare patient financial responsibilities for a given diagnosis
Reasonable and customary prices for services in a given area
What services or healthcare items are covered under Medicare
What services or healthcare items are covered under Medicare
What are some core elements if a board-approved financial assistance policy?
Payment requirements, staffing hours, and admission policies
Case management, payment methods, and discharge policies
Deposit requirements, pre-registration calling hours, and charity care policy
Eligibility, application process, and nonpayment collection activities
Eligibility, application process, and nonpayment collection activities
The ICD-10 codes set and CPT/HCPCS code sets combines provide
Pricing floors for services
The financial data required for activity-based costing
Patients an overview of services covered by their health insurance plan
The specificity and coding needed to support reimbursement claims
The specificity and coding needed to support reimbursement claims
A recurring/series registration is characterized by
A creation of multiple registrations for multiple services
The creation of one registration record for multiple days of service
The creation of multiple patient types for one date of service
The creation of one registration record per diagnosis per visit
The creation of one registration record for multiple days of service
Under EMTALA (Emergency Medical Treatment and Labor Act) regulations, the provider may not ask about a patient’s insurance information if it would delay what?
Complete course of treatment
Medical screening and stabilizing treatment
Admission to observation status
Transfer to another facility
Medical screening and stabilizing treatment
In resolving medical accounts, a law firm may be used as:
- An independent auditor of a financial assistance policy
- Legal counsel to patients regarding financing options
- An independent broker of patient financial assistance from banks
- A substitute for a collection agency
A substitute for a collection agency
The unscheduled “direct” admission represents a patient who:
- Is admitted from a physician’s office on an urgent basis
- Arrives at the hospital via ambulance for treatment in the emergency room
- Is an ambulatory patient who collapses in the hospital lobby
- Arrives on the medical helicopter for trauma services
Is admitted from a physician’s office on an urgent basis
the balance resolution process, providers should:
- Stress to the patient that serious consequences may result from refusal to pay
- Remind the patient of their legal responsibility to pay the balance due
- Ask the patient if he or she would like to receive information about
payment options and supportive financial assistance programs
Ask the patient if he or she would like to receive information about
payment options and supportive financial assistance programs
Which of the following in NOT included in the Standardized Quality Measures
- Clinical outcomes
- Patient perceptions
- Health care processes
- Cost of services
Cost of services
