CRCR Unit 2 2.1 - 2.7) Pre-Service -
Financial Care
Time-of-Service collection steps (The Program) - answer1. Begin interview with a
simple greeting to the patient.
2. Provide your name and explain why you are meeting at this time.
3. Treat the patient with respect and dignity trying to develop a rapport.
4. Inquire if the timing of the visit represents an acceptable time to talk about financial
matters.
5. Assume the patient may not understand how insurance works & how hospitals
charge for services. Be prepared to explain how you determined what the patient owes
& be prepared to show the calculations.
6. Once the patient understand how you arrived at the amount due, simply as for the
payment in full.
7. When receive payment, process it according to your hospital's receipting rules and
provide a detailed receipt to the patient.
Acute Healthcare Facility - what types of patients are there? - answerScheduled,
unscheduled, and non-acute types
Non-Acute Patient Types - answerSkilled nursing, hospice care,, home health services,
durable medical equipment (DME), and clinic.
Identify the different patient types and when to use each patient type - answerA.
Scheduled - healthcare facility knows the patient is coming ahead of time, any non
emergent clinical service. Can be registered ad inpatients outpatients,, or reoccurring /
series patient types.
B. Unscheduled - Many patients receive healthcare services that are not scheduled
ahead of time. The types include:
1. Inpatients or urgent patients
2. Outpatients or walk-in patients
3. Emergency patients
4. Observation patients
5. Newborns
,C. Non-Acute - services available to patients which are not normally provided in an
acute hospital setting.
1. Skilled nursing
2. Hospice care
3. Home health services
4. Durable medical equipment (DME)
5. Clinic
Scheduled patient types - answerPatients are considered scheduled if the healthcare
facility knows that the patient is coming ahead of time.
Normally schedule services that are high dollar and require significant pre-processing to
ensure appropriate reimbursement and/or significant resource coordination.
Any non-emergent clinical service is a candidate for scheduled patients in order to
reduce wait times and maximize patient flow.
Can be registered as inpatients, outpatients, or reoccurring / series patient types.
What is resource coordination - answerIncludes the following:
A. Reserving rooms and/or equipment
B. Ordering devices or supplies
C. Ensuring that professional staff (physicians, nurses, and/or technicians) is available.
Scheduled - outpatients - answerPatients that have services that do not involve an
overnight stay or, if they involve and overnight stay, the patient does not meet inpatient
acuity criteria.
Examples of scheduled outpatient services. - answerA. Routine diagnostic testing in
radiology (nuclear medicine, ultrasound, CT scan, PET scans, MRI's)
B. Pulmonary function testing
C. Interventional radiology
D. Cardiology testing (EKG's, EEG's, catheterizations, and stress tests)
E. Neurology
F. Ambulatory surgery
G. Pain management
H. Laboratory testing (many providers schedule some or all)
Scheduled - recurring/series patients - answerCertain services where the treatment is
ongoing are registered as recurring or series patients (also considered an outpatient
service). One registration is created and charges related to the ongoing treatment are
entered on one account for multiple days of service.
These accounts typically can be registered on a monthly basis if the treatment duration
exceeds 30 days.
, Examples of recurring / series patient services - answerA. Physical therapy
B. Occupational therapy
C. Speech therapy
D. Cardiac rehabilitation services
E. Pulmonary rehab
F. Nutrition counseling
G. Behavioral health therapy sessions
H. Behavioral health day programs
I. Intravenous (IV) therapy
J. Chemotherapy
K. Radiation therapy
Unscheduled patient types - answerMany patients receive healthcare services that are
not scheduled ahead of time. The types include:
A. Inpatients or urgent patients
B. Outpatients or walk-in patients
C. Emergency patients
D. Observation patients
E. Newborns
When is observation status NOT appropriate - answerA. As a substitute for an inpatient
admission or for continuous monitoring
B. For medically-stable patients who need testing or outpatient procedures
When is observation status appropriate - answerA. Patient waiting for nursing home
placement or as a convenience of the patient, family, physician or hospital
B. Routine preparation for procedures or for routine recovery from diagnostic or surgical
services
Unscheduled - Newborns - answerBabies delivered in the hospital are registered as a
newborn.
Non-Acute Patient Type - answerSkilled nursing, hospice care, home health services,
clinic services, and durable medical equipment (DME)
Non-Acute Type - Skilled Nursing - answerPatient are admitted when they can no
longer meet the criteria for acute care, but still need an inpatient level of skilled nursing
care or rehabilitation services.
Medicare will only cover services in a skilled nursing facility if the patient was
transferred after at least a 3 day inpatient stay for a related illness or injury.
As part of CMS ACO (Accountable Care Organization) model, the Medicare beneficiary
3 day inpatient stay requirement prior to admission to a SNF is waived for participating,
qualifying ACO's.
Financial Care
Time-of-Service collection steps (The Program) - answer1. Begin interview with a
simple greeting to the patient.
2. Provide your name and explain why you are meeting at this time.
3. Treat the patient with respect and dignity trying to develop a rapport.
4. Inquire if the timing of the visit represents an acceptable time to talk about financial
matters.
5. Assume the patient may not understand how insurance works & how hospitals
charge for services. Be prepared to explain how you determined what the patient owes
& be prepared to show the calculations.
6. Once the patient understand how you arrived at the amount due, simply as for the
payment in full.
7. When receive payment, process it according to your hospital's receipting rules and
provide a detailed receipt to the patient.
Acute Healthcare Facility - what types of patients are there? - answerScheduled,
unscheduled, and non-acute types
Non-Acute Patient Types - answerSkilled nursing, hospice care,, home health services,
durable medical equipment (DME), and clinic.
Identify the different patient types and when to use each patient type - answerA.
Scheduled - healthcare facility knows the patient is coming ahead of time, any non
emergent clinical service. Can be registered ad inpatients outpatients,, or reoccurring /
series patient types.
B. Unscheduled - Many patients receive healthcare services that are not scheduled
ahead of time. The types include:
1. Inpatients or urgent patients
2. Outpatients or walk-in patients
3. Emergency patients
4. Observation patients
5. Newborns
,C. Non-Acute - services available to patients which are not normally provided in an
acute hospital setting.
1. Skilled nursing
2. Hospice care
3. Home health services
4. Durable medical equipment (DME)
5. Clinic
Scheduled patient types - answerPatients are considered scheduled if the healthcare
facility knows that the patient is coming ahead of time.
Normally schedule services that are high dollar and require significant pre-processing to
ensure appropriate reimbursement and/or significant resource coordination.
Any non-emergent clinical service is a candidate for scheduled patients in order to
reduce wait times and maximize patient flow.
Can be registered as inpatients, outpatients, or reoccurring / series patient types.
What is resource coordination - answerIncludes the following:
A. Reserving rooms and/or equipment
B. Ordering devices or supplies
C. Ensuring that professional staff (physicians, nurses, and/or technicians) is available.
Scheduled - outpatients - answerPatients that have services that do not involve an
overnight stay or, if they involve and overnight stay, the patient does not meet inpatient
acuity criteria.
Examples of scheduled outpatient services. - answerA. Routine diagnostic testing in
radiology (nuclear medicine, ultrasound, CT scan, PET scans, MRI's)
B. Pulmonary function testing
C. Interventional radiology
D. Cardiology testing (EKG's, EEG's, catheterizations, and stress tests)
E. Neurology
F. Ambulatory surgery
G. Pain management
H. Laboratory testing (many providers schedule some or all)
Scheduled - recurring/series patients - answerCertain services where the treatment is
ongoing are registered as recurring or series patients (also considered an outpatient
service). One registration is created and charges related to the ongoing treatment are
entered on one account for multiple days of service.
These accounts typically can be registered on a monthly basis if the treatment duration
exceeds 30 days.
, Examples of recurring / series patient services - answerA. Physical therapy
B. Occupational therapy
C. Speech therapy
D. Cardiac rehabilitation services
E. Pulmonary rehab
F. Nutrition counseling
G. Behavioral health therapy sessions
H. Behavioral health day programs
I. Intravenous (IV) therapy
J. Chemotherapy
K. Radiation therapy
Unscheduled patient types - answerMany patients receive healthcare services that are
not scheduled ahead of time. The types include:
A. Inpatients or urgent patients
B. Outpatients or walk-in patients
C. Emergency patients
D. Observation patients
E. Newborns
When is observation status NOT appropriate - answerA. As a substitute for an inpatient
admission or for continuous monitoring
B. For medically-stable patients who need testing or outpatient procedures
When is observation status appropriate - answerA. Patient waiting for nursing home
placement or as a convenience of the patient, family, physician or hospital
B. Routine preparation for procedures or for routine recovery from diagnostic or surgical
services
Unscheduled - Newborns - answerBabies delivered in the hospital are registered as a
newborn.
Non-Acute Patient Type - answerSkilled nursing, hospice care, home health services,
clinic services, and durable medical equipment (DME)
Non-Acute Type - Skilled Nursing - answerPatient are admitted when they can no
longer meet the criteria for acute care, but still need an inpatient level of skilled nursing
care or rehabilitation services.
Medicare will only cover services in a skilled nursing facility if the patient was
transferred after at least a 3 day inpatient stay for a related illness or injury.
As part of CMS ACO (Accountable Care Organization) model, the Medicare beneficiary
3 day inpatient stay requirement prior to admission to a SNF is waived for participating,
qualifying ACO's.
