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What are some core elements if a board-approved financial assistance policy? Eligibility, application process, and nonpayment collection activities A recurring/series registration is characterized by The creation of one registration record for multiple days of service With the advent of the Affordable Care Act Health Insurance Marketplaces and the expansion of Medicaid in some states, it is more important than ever for hospitals to Assist patients in understanding their insurance coverage and their financial obligation The purpose of a financial report is to: Present financial information to decision makers Patient financial communications best practices produce communications that are
Consistent, clear and transparent Medicare has established guidelines called the Local Coverage Determinations (LCD) and National Coverage Determinations (NCD) that establish What services or healthcare items are covered under Medicare Any provider that has filed a timely cost report may appeal an adverse final decision received from the Medicare Administrative Contractor (MAC). This appeal may be filed with The Provider Reimbursement Review Board Concurrent review and discharge planning Occurs during service Duplicate payments occur: When providers re-bill claims based on nonpayment from the initial bill submission An individual enrolled in Medicare who is dissatisfied with the government's claim determination is entitled to reconsideration of the decision. This type of appeal is known as A beneficiary appeal
Provide a method of measuring the collection and control of A/R he patient discharge process begins when The physician writes the discharge orders 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. The soft cost of a dissatisfied customer is The customer passing on info about their negative experience to potential pts or through social media channels An advantage of a pre-registration program is The opportunity to reduce the corporate compliance failures within the registration process It is important to have high registration quality standards because Inaccurate or incomplete patient data will delay payment or cause denials
Telemed seeks to improve a patient's health by Permitting 2-way real time interactive communication between the patient and the clinical professional Any healthcare insurance plan that provides or ensures comprehensive health maintenance and treatment services for an enrolled group of persons based on a monthly fee is known as a HMO 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 Medicare Part B has an annual deductible, and the beneficiary is responsible for A co-insurance payment for all Part B covered services The standard claim form used for billing by hospitals, nursing facilities, and other inpatient UB- 04
The healthcare industry is vulnerable to compliance issues, in large part due to the complexity of the statutes and regulations pertaining to Medicare and Medicaid payments The Correct Coding Initiative Program consists of Edits that are implemented within providers' claim processing systems To provide a patient with information that is meaningful to them, all of the following factors must be included EXCEPT The actual physician reimbursement Which department supports/collaborates with the revenue cycle? Information Technology Medicare Part B has an annual deductible and the beneficiary is responsible for a co-insurance payment for all Part B covered services
The two types of claims denial appeals are Beneficiary and Provider Which of the following is a violation of the EMTALA (Emergency Medical Treatment and Labor Act?) Registration staff members routinely contact managed care plans for prior authorizations before the patient is seen by the on duty physician Rural Health Clinics (RHC) personnel can provide services in all of the following locations, EXCEPT Providing inpatient services in the RHC The patient discharge process begins when The physician writes the discharge order Departments that need to be included in charge master maintenance include all of the following EXCEPT Quality Assurance
Components of financial education include informing the patient of the hospital's financial policies, assessing the patient's ability to pay and Reviewing payment alternatives with the patient so appropriate resolution of the health care financial obligation is achieved We have an expert-written solution to this problem! HFMA best practices indicate that the technology evaluation is conducted to Continually align technology with processes rather than technology dictating processes Scheduler instructions are used to prompt the scheduler to Complete the scheduling process correctly based on service requested When billing Rural Health Clinic services on a UB-04/837-I, specific CPT codes are collapsed into a single revenue code (520 or 521). Although codes are collapsed into a single revenue code, it is still important to list the appropriate CPT codes as part These codes will be used to determine medical necessity and useful in determining what happened during the encounter What is likely to occur if credit balances are not identified separately from debit balances in accounts receivable? The accounts receivable level would be understated
The process of verifying health insurance coverage, identifying contract terms, and obtaining total charges is known as insurance verification and reimbursable charges We have an expert-written solution to this problem! Unless the patient encounter is an emergency, it is more efficient and effective to Collect all information after the patient has been discharged Applying the contracted payment amount to the amount of total charges yields A pricing agreement "Hard-coded" is the term used to refer to Codes for services, procedures, and drugs automatically assigned by the charge master The advantages to using a third-party collection agency include all of the following EXCEPT Providers pay pennies on each dollar collected
Is admitted from a physician's office on an urgent basis In resolving medical accounts, a law firm may be used as: A substitute for a collection agency The legal authority to request and analyze provider claim documentation to ensure that The Office of the U.S. Inspector General (OIG) The office of inspector general (OIG) publishes a compliance work plan Annually Room and bed charges are typically posted From the midnight census All of the following information should be reviewed as part of schedule finalization EXCEPT: The results of any and all test
Revenue cycle activities occurring at the point-of-service include all of the following EXCEPT: Providing charges to the third-party payer as they are incurred HFMA's patient financial communications best practices specify that pts should be told about the The service providers that typically participate in the service, e.g. radiologists ,pathologists, etc. The core financial activities resolved within patient access include: Scheduling, pre-registration, insurance verification and managed care processing A decision on whether a patient should be admitted as an inpatient or become about patient observation patient requires medical judgments based on all of the following EXCEPT The patient's home care coverage Which option is a benefit of pre-registering a patient for services The patient arrival process is expedited, reducing wait times and delays Days in A/R is calculated based on the value of
Medicare beneficiaries remain in the same "benefit period" Until the beneficiary is "hospitalization and/or skilled nursing facility-free" for 60 consecutive days It is important to calculate reserves to ensure Stable financial operations and accurate financial reporting A claim is denied for the following reasons, EXCEPT: The submitted claim does not have the physicians signature Overall aggregate payments made to a hospice are subject to a computed "cap amount" calculated by The Medicare Administrative Contractor (MAC) at the end of the hospice cap period Which of the following is required for participation in Medicaid Meet Income and Assets Requirements In choosing a setting for patient financial discussions, organizations should first and foremost Respect the patients privacy
A nightly room charge will be incorrect if the patient's Transfer from ICU (intensive care unit) to the Medical/Surgical floor is not reflected in the registration system The Affordable Care Act legislated the development of Health Insurance Exchanges, where individuals and small businesses can Purchase qualified health benefit plans regardless of insured's health status A portion of the accounts receivable inventory which has NOT qualified for billing includes: Charitable pledges What is required for the UB-04/837-I, used by Rural Health Clinics to generate payment from Medicare? Revenue codes We have an expert-written solution to this problem! 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
HFMA best practices call for patient financial discussions to be reinforced By changing policies to programs Patients should be informed that costs presented in a price estimate may Vary from estimates, depending on the actual services performed The nuanced data resulting from detailed ICD-10 coding allows senior leadership to work with physicians to do all of the following EXCEPT: Obtain higher compensation for physicians Charges as the most appropriate measurement of utilization enables Accuracy of expense and cost capture Once the EMTALA requirements are satisfied The remaining registration processing is initiated at the bedside or in a registration area
Across all care settings, if a patient consents to a financial discussion during a medical encounter to expedite discharge, the HFMA best practice is to: Support that choice, providing that the discussion does not interfere with patient care or disrupt patient flow In Chapter 7 straight bankruptcy filling The court liquidates the debtor's nonexempt property, pays creditors, and discharges the debtor from the debt Chapter 13 Bankruptcy, debtor rehabilitation is a court proceeding That reorganizes a debtor's holdings and instructs creditors to look to the debtors' future earnings for payment This concept encompasses all activities required to send a request for payment to a third-party health plan for payment of benefits Claims processing The importance of Medical records being maintained by HIM is that the patient records: Are the primary source for clinical data required for reimbursement
