Rev Cycle 4 Flashcards
In the pre-service stage, the requested service is screened for medical necessity, health
plan coverage and benefits are verified and:
- Billing authorization is signed by the patient
- The patient signs the consents for treatment
- The patient signs a statement attesting an understanding and acceptance of payment
policies
• Pre-authorization are obtained
Pre-authorization are obtained
Improving the overall patient experience requires revenue cycle leadership and staff to
simultaneously be:
- Clear on policies and consistent in applying the policies
- Careful in screening patient demands
- Monitoring the costs and charges the patient incurs
- Inquisitive, responsive and flexible
Clear on policies and consistent in applying the policies
Hospitals need which of the following information sets to assess a patient’s financial
status:
- Income, expenses, debt
- Patient and guarantor’s income, expenses and assets
- Income, expenses and capacity to take on more debt
- Assets liquidity, Income, expenses, credit worthiness
Patient and guarantor’s income, expenses and assets
cycle activities I the Time of Service stage DO
NOT INCLUDE:
- Pre-registration record is activated, consents are signed, and co-payment is collected
- Positive patient identification is completed, and patient is given an armband
- Final bill is presented for payment
- Preprocessed patients may report to a designated “express arrival” desk
Final bill is presented for payment
The Electronic Remittance Advice (ERA) data set is :
- Used for Electronic Funds Transfers between hospitals and a bank
- A standardized form that provides 3rd party payment details to
providers
- Required for annual Medicare quality reporting forms
- Safeguards the Electronic claims process
A standardized form that provides 3rd party payment details to
providers
Appropriate training for patient financial counseling staff must cover all of the following
EXCEPT:
- Patient financial communications best practices specific to staff role
- Financial assistance policies
- Documenting the conversation in the medical records
- Available patient financing options
Documenting the conversation in the medical records
All of the following information should be reviewed as part of schedule finalization
EXCEPT:
- The results of any and all test
- The service to be provided
- The arrival time and procedure time
- The patient’s preparation instructions
The results of any and all test
Indemnity plans usually reimburse:
- Only for contracted Services
- A claim up to 80% of the charges
- A certain percentage of the charges after the patient meets the
policy’s annual deductible
• A patient for out-of-pocket charges
A certain percentage of the charges after the patient meets the
policy’s annual deductible
Because 501(r) regulations focus on identifying potential eligible financial assistants
patients hospitals must:
- Capture their experience with such patients to properly budget
- Hold financial conversations with patients as soon as possible
- Build the necessary processes to handle the potentially lengthy payment schedule
- Expedite payment processing of normal accounts receivable to protect cash flow
Hold financial conversations with patients as soon as possible
Which option is a benefit of pre-registering a patient for services
• The patient arrival process is expedited, reducing wait times and
delays
- The verification of insurance after completion of the services
- Service departments have the ability to override schedules and block time to reduce
testing volume
• The patient receiving multiple calls from the provider
The patient arrival process is expedited, reducing wait times and
delays
HIPPA had adopted Employer Identification Numbers (EIN) to be used in standard
transactions to identify the employer of an individual described in a transaction EIN’s are
assigned by
- The Social Security Administration
- The US department of the Treasury
- The United States department of labor
The Internal Revenue Service
The nightly room charge will be incorrect if the patient’s
• Transfer from ICU to the Medical/Surgical floor is not reflected in the
registration system.
- Pharmacy orders to the ICU have not been entered into the pharmacy system
- Condition has not been discussed during the shift change report meeting
- Discharge for the next day has not been charted
Transfer from ICU to the Medical/Surgical floor is not reflected in the
registration system.
With any remaining open balances, after insurance payments have been posted, the
account financial liability is
- Written off as bad debt
- Potentially transferred to the patient
- Sold to a collection agency
- Treated as the cost of doing business
Potentially transferred to the patient
When there is a request for service the scheduling staff member must confirm the patient’s
unique identification information to:
- Verify the patient’s insurance coverage if the patient is a returning customer
- Ensure that she/he accesses the correct information in the historical
database
- Confirm that physician orders have been received
- Check if any patient balance due
Ensure that she/he accesses the correct information in the historical
database
Identifying the patient, in the MPI, creating the registration record, completing medical
necessity screening, determining insurance eligibility and benefits resolving managed
care, requirements and completing financial education/resolution are all
- The data collection steps for scheduling and pre-registering a patient
- Registration steps that must be completed before any medical services are provided
- The steps mandated for billing Medicare Part A
- The process of closing an account
The data collection steps for scheduling and pre-registering a patient
the following
- The accurate identification of the patient’s eligibility and benefits
- The consistent formatting of the patient’s name and identification number
- The resolution of managed care and billing requirements
- The identification of physician fee schedule amounts and the NPI (national provider
identifier) numbers
The accurate identification of the patient’s eligibility and benefits
A four digit number code established by the National Uniform Billing Committee (NUBC)
that categorizes/classifies a line item in the charge master is known as
- HCPCs codes
- ICD-10 Procedural codes
- CPT codes
- Revenue codes
Revenue codes
The importance of Medical records being maintained by HIM is that the patient records:
- Are evidence used in assessing the quality of care
- 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 the evidence cited in quality review
Are the primary source for clinical data required for reimbursement
by health plans and liability payers
Medicare patients are NOT required to produce a physician order to receive which of
these services
- Diagnostic Mammography, flu vaccine, or B-12 shots
- Diagnostic Mammography, flu vaccine, or pneumonia vaccine
- Screening Mammography, flu vaccine or pneumonia vaccine
- Screening Mammography, flu vaccine or B-12 shots
Screening Mammography, flu vaccine or pneumonia vaccine
Patients should be informed that costs presented in a price estimate may
- Vary from estimates, depending on the actual services performed
- Be guaranteed if the patient satisfies all patient financial responsibilities at the time
of registration
- Be lower as price estimates use the highest market price
- Only determine the percentage of the total that the patient is responsible for and not
the actual cost
Vary from estimates, depending on the actual services performed
the health plan for
- All pre-admission emergency transports
- Transport deemed medically necessary by the attending paramedic-ambulance crew
- Services provided before a patient is admitted and for ambulance
rides arranged to pick up the patient from the hospital after discharge
to take him/her home or to another facility
• The portion of the bill outside of the patient’s self-pay
Services provided before a patient is admitted and for ambulance
rides arranged to pick up the patient from the hospital after discharge
to take him/her home or to another facility
In Chapter 7 straight bankruptcy filling
• The court establishes a creditor payment schedule with the longest outstanding claims
paid first
• The court liquidates the debtor’s nonexempt property, pays creditors,
and discharges the debtor from the debt
• The court vacates all claims against a debtor with the understanding that the debtor
may not apply for credit without court supervision
• The court liquidates the debtor’s nonexempt property, pays creditors, and begins to
pay off the largest claims first. All claims are paid some portions of the amount owed.
The court liquidates the debtor’s nonexempt property, pays creditors,
and discharges the debtor from the debt
The activity which results in the accurate recording of patient bed and level of care
assessment, patient transfer and patient discharge status on a real-time basis is known as
- Utilization review
- Case management
- Census management
- Patient through-put
Case management
Which of the following is required for participation in Medicaid
- Obtain a supplemental health insurance policy
- Meet income and assets requirements
- Meet a minimum yearly premium
- Be free of chronic conditions
Meet income and assets requirements
When primary payment is received, the actual reimbursement
- Is compared to the expected reimbursement
- Is recorded by Patient Accounting and the patient’s account is the closed
- Is compared to the expected reimbursement, the remaining
contractual adjustments are posted, and secondary claims are
submitted
• Trigger that the secondary claims can then be prepared.
Is compared to the expected reimbursement, the remaining
contractual adjustments are posted, and secondary claims are
submitted
Days in A/R is calculated based on the value of
- Total cash received to date
- The time it takes to collect anticipated revenue
- The total accounts receivable on a specific date
- Total anticipated revenue minus expenses
The total accounts receivable on a specific date
All of the following are forms of hospital payment contracting EXCEPT
- Per diem payment
- Bundled Payment
- Fixed Contracting
- Contracted Rebating
Contracted Rebating
The standard claim form used for billing by hospitals, nursing facilities, and other in-patient
services is called the
- UB-04
- 1500
- COST REPORT
- REMITTANCE NOTICE
UB-04
To maximize the value derived from customer complaints, all consumer complaints should be
- Responded to within two business days
- Tracked and shared to improve the customer experience
- Handled by a specially trained “service recovery” team
- Brought immediately to management’s attention
Responded to within two business days
assessment of healthcare providers and systems) initiative
was launched to
- Gather national date on overall trust in the nation’s health care system
- Create a national database on physician quality
- Provide a standardized method for evaluating patient’s perspective on
hospital care. ?
• Provide data for building shared savings reimbursement for quality procedures.
Provide a standardized method for evaluating patient’s perspective on
hospital care. ?
Health Plan Contracting Departments do all of the following EXCEPT
- Establish a global reimbursement rate to use with all third-party payer
- Review all managed care contracts for accuracy for loading contract terms into the
patient accounting system
• Review payment schemes to ensure that the health plan and provider understand how
reimbursements must be calculated
• Review contracts to ensure the appeals process for denied claims is clearly specified
Establish a global reimbursement rate to use with all third-party payer
