CRCR Study

CRCR Study 2023 Patient Centric Revenue Cycle Ans- This includes all the major processing steps required to process a pt account from the request for service through closing the account with a zero balance and purging it from the system pre-service Ans- this is the period in which scheduling and pre-access takes place, including different steps that will be completed pre-service Ans- what is it when the requested service is screened for medical necessity, health plan coverage & benefits are verified, and pre-auth is obtained scheduled patient- Time of Service Ans- what is it when a final account review is completed prior to the patient's arrival? (Pre-reg record is activated, consents are signed, and co-payments and other amounts are collected) express arrival Ans- pre-processed patient's can report to this, which is a desk located in a centralized access, upon their arrival. post-service Ans- this includes account activities that occur after the patient is d/c until the account reaches a zero balance post-service Ans- Final coding of all services, perparation and submission of claims, payment processing and balance billing are all included and finalized when? Patient Financial Communications Best Practices Ans- This brings consistency, clarity, and transparency to patient financial communications Patient Financial Communications Best Practices Ans- this outlines steps to help patient's understand the cost of services they receive, their insurance coverage, and their individual responsibility (review Patient Financial Comm. Best Practice document) true Ans- true or false: Conversations should occur in a location and manner that are sensitive to the patient's needs timely discussions Ans- this type of discussion will help ensure that patient's understand their financial obligation and that providers are aware of the patient's ability to pay guarantor Ans- the person responsible for payment of the bill true Ans- true or false: A financial counselor or supervisor should be involved for complex situations such as uninsured or underinsured patient's false; NO patient financial discussions should occur before a patient is screened and stabilized Ans- true or false: You MUST obtain basic registration info and insurance coverage before the patient is cared for in the ED. true Ans- true or false: When the provider takes the initiative to communicate financial matters with the patient, it actually take a burden off the patient. false; Technology evaluation may be performed by ANY qualified individual or organization, internal or external Ans- true or false: Technology evaluation can ONLY be done by a qualified individual, internal to the facililty HFMA's Adopter Program Ans- this program is a recognition for providers who implement and support the best practices are eligible and encouraged to apply Code of Conduct Ans- Through what document does a hospital est. compliance standards? Identify acceptable compliance programs in various provider setting Ans- what is the purpose OIG work plan? non-diagnostic services provided on Tuesday through Friday Ans- If a Medicare pt is admitted on Friday, what services fall within the 3-day DRG window rule? reports a specific circumstance that affects a procedure or service without changing the code or its definition. Ans- What does a modifier allow a provider to do? they must be billed separately to the Part B carrier Ans- if OP diagnostic services are provided within 3 day of admission of a medicare beneficiary to an IPPS (Inpatient Prospective Payment system) hospital, what must happen? One registration record is created for multiple days of service Ans- What is recurring or series registration? unscheduled patients Ans- what are non-emergency pt who come for service w/o prior notification to the provider called? used to evaluate the need for an IP admission Ans- Which of the following statements apply to the Obs patient type? physician, nursing, and pharmacy Ans- which services are hospice programs required to provide on a around-the-clock patient?q complete the scheduling process correctly based on service requested Ans- Scheduler instructions are used to prompt the scheduler to do what? procedure time Ans- This is the time needed to prepare the patient before services is the difference between the patients arrival time? Documentation of the medical necessity for the test Ans- Medicare guidelines require that when a test is ordered for which an LCD (local cover determination) or NCD (national coverage determination) exists, the info on the order must include what? it reduces processing times at the time of service Ans- what is an advantage of a pre-registration program? the responsible party's full legal name, DOB, and SSN Ans- what data is required to est. a new MPI (Master patient index) entry? parents are received by the provider from the payer responsible for reimbursing the provider for the pt covered services Ans- which of the following statements is true about third-party payments? stop loss Ans- which provision protects the patient from medical expenses that exceed pre-set level? referral Ans- What is it called when a PCP send an HMO (health maintenance organization) pt to authorize a visit to a specialist for additional testing or care? Medical screening and stabilizing Ans- under the EMTALA (emergency medical treatment and labor act) regulations, the provider may not ask the patient about their ins info if it would delay what? to the approved APC rate Ans- the hospital has a APC (ambulatory payment classification) - based contract for the payment of OP services. Total anticipated charges for the visit are $2,380. The approved APC payment rate is $780. Where will the patients benefit package be applied? $100 Ans- a patient has met their $200 deductible and $900 of the $1000 coins responsibility. the coins rate is 20%. The estimated ins plan responsibility is $1975.00. What amount of coins is due from the patient? the pt outstanding medical bills exceed a defined dollar amount or percentage of assets Ans- when is a pt considered to be medically indigent? sources of readily available funds, such as vehicles, campers, boats and savings accounts Ans- what patient assets are considered in the financial assistance applications? warn the pt that any unpaid accounts are placed with collection agencies for further processing Ans- if the pt cannot agree to payment arrangements, what is the next option? scheduling, pre-reg, ins verification, and managed care processing Ans- what core financial activities are resolved within patient access? a pt who arrives at the hospital via EMS for treatment in the ER Ans- what is an unscheduled direct admission? as a substitute for an IP admission Ans- when is not appropriate to use observation status? home health Ans- parents who require periodic skilled nursing or therapeutic care receive services from what type of program? printed copy of the providers privacy notice Ans- every pt who is new to the healthcare provider must be offered what? the employer provides a traditional HMP health plan Ans- which of the follo