CRCR Exam Unit 1 All Answers Correct

CRCR Exam Unit 1 All Answers Correct Net Days in AR Ans- Measures how fast receivables are collected. It is a trending indicator of overall A/R performance & revenue cycle efficiency. A/R Aging Ans- Reports divide the AR into 30, 60, 90, and 120 day categories, based on discharge. Credit Balances - Days Outstanding Ans- The dollars in credit balance at the account level divided by the three month daily average of total net patient service revenue. Credit balances should be resolved timely and should be benchmarked at 1% of the days outstanding in the AR. 3 Critical Elements of the Healthcare Revenue Cycle Ans- Pre-Service, Time of Service, Post Service Provision of Care Ans- Describing elective vs. non-elective services to the patient, and discussing prior balances the patient has (if applicable). Emergency Medical Treatment and Active Labor Act (EMTALA) Ans- Says that no patient financial discussions should occur before a patient is screened and stabilized. HFMA's Adopter Program Ans- Providers who implement and support the best practices of Patient Financial Communication are eligible and encouraged to apply for recommendation by HFMA as an Adopter of Patient Financial Communication Best Practices. Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Initiative AnsImplemented by CMS to provide a standardized method for evaluating patient's perspective on hospital care. 27 total questions on the survey. Key Question is "Would you recommend this hospital to your friends and family?" Continuum of Care Ans- Involves healthcare providers in multiple settings and multiple levels coming together with the overall goal of coordinating patients' healthcare Transfer Agreements Ans- To participate in the Medicare program, a SNF must have written transfer agreement with one or more participating hospitals providing for the transfer of patients between the hospital and the SNF, and for the interchange of medical and other information. Office of the Inspector General (OIG) Ans- Developed the Model Compliance Plan for clinical Laboratories in 1997, and the Compliance Program Guidance for Hospitals in 1998, followed by almost a dozen other guidance documents. Oversees medical billing compliance. Essential Elements in a Corporate Compliance Program Ans- Have a Plan Follow the Plan Review the Code of Conduct to verify you follow the plan Fraud Enforcement and Recovery Act (FERA) Ans- Signed into law in 2009, which amended the False Claims Act (FCA) in several important respects, including the closure of loopholes and enhancement of the ability of government whistleblowers, and reporting individuals to identify and successfully pursue entities and individuals who improperly receive government funds. The Healthcare Insurance and Portability Act (HIPPA) Ans- Passed in 1996, includes requirements that specifically address compliance include the following: Coordinating a fraud and abuse control program Establishing a fraud and abuse control account Increasing the civil money penalties Permitting the exclusion of individuals with ownership or control interest in a sanctioned entity. Also created National Provider Identifiers (NPI) were created to eliminate the myriad of other provider IDs previously used. The Health Information Technology for Electronic and Clinical Health (HITECH) Ans- Passed in 2009 to promote the adoption of meaningful use of health IT. Addressed the privacy and security concerns associated with the electronic transmission of health information. The rule became effective on March 26th and compliance was required as of 9.23.13. Medicare DRG Three-Day Payment Window Ans- All diagnostic services provided to a Medicare beneficiary on the day of the patient's IP admission or during the 3 calendar days (or in the case of a non-IPPS hospital, 1) immediately following preceding the date of admission are required to be included on the bill for the inpatient stay, unless there is no Part A coverage. Advanced Beneficiary Notification Requirements (ABN) Ans- As soon as a provider determines that Medicare will most likely not pay, it must advise the beneficiary that, in the provider's opinion, he/she will be personally responsible for the payment. This involves the timely and effective delivery of the approved CMS form to the individual beneficiary or to the beneficiary's authorized representative. Two Midnight Rule Ans- Created in FY 2014 to address ambiguity surrounding who decides what services must be performed in an IP setting. Says CMS will generally consider hospital admissions spanning two midnights as appropriate for payment under IPPS. Hospital stays of 2 midnights will generally be considered OP cases, regardless of clinical severity. Procedures defined as "IP-only" are exceptions to the rule and may be appropriately furnished on an IP basis regardless of the beneficiary's LOS, not do not constitute an all-inclusive list. Medicare Secondary Payer (MSP) Ans- From the beginning of the Medicare program, specific to traditional fee-for-service, certain payers have always been liable for payment of claims. In these cases, Medicare does not make a secondary payment. The amounts paid by the primary payers are considered payment in full. Typical MSPs are Worker's Comp, Veterans Administration, and Federal grant programs. Medicare Secondary Payer Situations Ans- Working Aged (employer has 20 employees), Accident or other Liability, Disability, and ESRD patients (after the 30-month coordination period) Correct Coding Initiative (CCI) Ans- Created to promote the use of correct coding methods on a national basis. Purpose is to ensure that the most comprehensive groups of codes, rather than component parts, are billed. Consists of edits that are implemented within providers' claim processing systems. Ethics Violations Examples Ans- Financial Misconduct, Overcharging, Theft of Property, Falsifying records to boost reimbursement, Miscoding claims. Affordable Care Act (ACA) Ans- Federal legislation passed in 2010 designed to reform the healthcare system into one that rewards greater value, improves quality of care, and increases efficiency in delivery of services. Accountable Care Organizations (ACO) Ans- Delivery system of physicians, hospitals, and other healthcare providers, working collaboratively to manage and coordinate the care of a patient population. The point is to ensure appropriateness of care, elimination of duplicate services, and prevention of medical errors for a population of patients. Types of ACOs being tested Ans- Medicare Shared Saving Program, Pioneer ACO, Investment Model ACO, Comprehensive ESRD Model Income Statement Ans- Ties directly to the Balance Sheet and is the summary of the organization's revenues and expenses and any excess or loss from operations. Balance Sheet Ans- A summary of the organization's wealth as of the date of the statement. It represents the summary of the organization's assets, liabilities, and accumulated excesses from operations less any accumulated losses. The net value of excesses and losses may be known as net assets. Cash Flow Statement Ans- Summary of how cash was used and where it was obtained. Accrual Accounting Ans- Revenue is recorded when it is earned to permit the alignment of revenue with the associated expenses. Healthcare providers usually use this method. Fund Accounting Ans- Record-keeping method to manage categories of net assets to ensure compliance with the restrictions on those funds. Gross Revenue Ans- Total of charges entered for all patients for the services they received Net Revenue Ans- The difference between the amount billed and the amount that the payer(s) has committed to pay based on an agreement with the provider. Contra-Account Amounts Ans- Adjustments posted at the time of billing. this increases the accuracy of the receivable and minimizes the need to estimate contractual reserves