CRCR Unit 1 Review
The 3 patient-centric revenue cycle processing steps - answerPre-service, time-of-
service, post-service
Pre-service steps - answerPatient scheduled and pre-registered, encounter record
generated, patient and guarantor information is obtained, medical necesity-health plan
coverage verified-pre-auth, cost of service determined, additional processing for not
medically necessary procedures, explanation of patients financial responsibility
Time of service steps - answerPatient arrives and pre-registered information is pulled
up. Consents signed and amounts collected. Positive ID completed and armband given.
Post service steps - answerAfter the patient is discharged until the account reaches a
zero balance such as final coding, prep and submission of claims, payment processing
and balance billing
What happens during the post-service stage? - answerFinal coding of all services,
preparation and submission of claims, payment processing and balance billing and
resolution.
What happens during the pre-service segment? - answerScheduling and pre-access
processing is completed. The patient is scheduled, pre-registered for service and the
required data is collected.
What happens during time-of-service segment? - answerFinal account review is
completed for a scheduled patient prior to arrival. Upon arrival, patient is positively
identified, pre-registration record activated, consents are signed, copays collected.
What is done at time-of-service for unscheduled patients? - answerComprehensive
registration and financial processing is completed which mirrors the work that was
completed for scheduled patients.
, 3 components to Healthcare Dollars and Sense Revenue Cycle initiative? -
answerMedical Account Resolution, Pricing Transparency, Patient Financial
Communications
When is it appropriate to discuss financial items for a ED patient? - answerAfter the
patient has been stabilized or during the discharge process. As long as it does not
interfere with the patients care.
What is the objective of the HCAHPS initiative? - answerTo provide a standardized
method for evaluating patients' perspective on hospital care.
Examples of a continuum of care provider? - answerSkilled Nursing Facility, Physician,
Hospice
What are types of OIG compliance issues published? - answerMedical devices, provider
based status, reconciliation of outlier payments
3 goals of HIPAA - answerExpand health coverage by improving portability, give
patients access to health files and the right to request amendments or make
corrections, facilitate the electronic exchange of medical information.
CMS developed in order to promote the use of correct coding methods on a national
basis. - answerCorrect Coding Initiative (CCI)
Three-Day DRG Window Rule - answerRequires certain outpatient services that are
provided within three days of the admit date to be billed as part of an inpatient stay.
Purpose of the ABN - answerTo inform Medicare beneficiary what Medicare will not pay
for.
4 situations where Medicare acts as secondary payer - answerWorking Aged, Accident
or other liability, disability, End stage renal disease (ESRD)
What is the intended outcome of collaborations made through an ACO delivery system?
- answerTo ensure appropriateness of care, elimination of duplicate services, and
prevention of medical errors for a population of patients.
3 types of reserve amounts on a providers financial statement - answerBad Debt,
contractual allowance accounts, charity care
4 reasons why ACA was passed and signed into law - answerImprove the quality of
care, reform the healthcare delivery system, encourage pricing transparency and
modernized financing systems, address the issue of waste, fraud, and abuse.
The 3 patient-centric revenue cycle processing steps - answerPre-service, time-of-
service, post-service
Pre-service steps - answerPatient scheduled and pre-registered, encounter record
generated, patient and guarantor information is obtained, medical necesity-health plan
coverage verified-pre-auth, cost of service determined, additional processing for not
medically necessary procedures, explanation of patients financial responsibility
Time of service steps - answerPatient arrives and pre-registered information is pulled
up. Consents signed and amounts collected. Positive ID completed and armband given.
Post service steps - answerAfter the patient is discharged until the account reaches a
zero balance such as final coding, prep and submission of claims, payment processing
and balance billing
What happens during the post-service stage? - answerFinal coding of all services,
preparation and submission of claims, payment processing and balance billing and
resolution.
What happens during the pre-service segment? - answerScheduling and pre-access
processing is completed. The patient is scheduled, pre-registered for service and the
required data is collected.
What happens during time-of-service segment? - answerFinal account review is
completed for a scheduled patient prior to arrival. Upon arrival, patient is positively
identified, pre-registration record activated, consents are signed, copays collected.
What is done at time-of-service for unscheduled patients? - answerComprehensive
registration and financial processing is completed which mirrors the work that was
completed for scheduled patients.
, 3 components to Healthcare Dollars and Sense Revenue Cycle initiative? -
answerMedical Account Resolution, Pricing Transparency, Patient Financial
Communications
When is it appropriate to discuss financial items for a ED patient? - answerAfter the
patient has been stabilized or during the discharge process. As long as it does not
interfere with the patients care.
What is the objective of the HCAHPS initiative? - answerTo provide a standardized
method for evaluating patients' perspective on hospital care.
Examples of a continuum of care provider? - answerSkilled Nursing Facility, Physician,
Hospice
What are types of OIG compliance issues published? - answerMedical devices, provider
based status, reconciliation of outlier payments
3 goals of HIPAA - answerExpand health coverage by improving portability, give
patients access to health files and the right to request amendments or make
corrections, facilitate the electronic exchange of medical information.
CMS developed in order to promote the use of correct coding methods on a national
basis. - answerCorrect Coding Initiative (CCI)
Three-Day DRG Window Rule - answerRequires certain outpatient services that are
provided within three days of the admit date to be billed as part of an inpatient stay.
Purpose of the ABN - answerTo inform Medicare beneficiary what Medicare will not pay
for.
4 situations where Medicare acts as secondary payer - answerWorking Aged, Accident
or other liability, disability, End stage renal disease (ESRD)
What is the intended outcome of collaborations made through an ACO delivery system?
- answerTo ensure appropriateness of care, elimination of duplicate services, and
prevention of medical errors for a population of patients.
3 types of reserve amounts on a providers financial statement - answerBad Debt,
contractual allowance accounts, charity care
4 reasons why ACA was passed and signed into law - answerImprove the quality of
care, reform the healthcare delivery system, encourage pricing transparency and
modernized financing systems, address the issue of waste, fraud, and abuse.
