CRCR SECTION 3
What does EMTALA require hospitals to do? - answerto provide a medical screening
examination and stabilizing treatment to every person presenting at an ED and
requesting medical evaluation or treatment
What is the first critical step for all patients arriving for service, scheduled or
unscheduled? - answerverifying the patient's identification with a combination of two
identifiers from a valid information source
Admission process forms include: - answerconsent to treatment, conditions of
admission, privacy notice, important message from Medicare, advance directives and
medical power of attorney, patient bill of rights
EMTALA prohibits inquires about health care or liability payer information if the inquiry
will delay examination or treatment. What other requirements apply to the Emergency
Department registration work? - answerpatients are initially triaged by medical
personnel and a "quick" registration initiated to allow electronic order entry and
documentation, identification and verification of insurance eligibility and benefits once
the medical screening has been completed, no additional registration may occur until
the patient is stabilized
Typical activities which must be performed when an unscheduled patient arrives for a
service include: - answeridentification of patient in the MPI or initiation of a new MPI
record, insurance verification of eligibility and benefits, managed care screening,
medical necessity screening, price estimation and financial counseling to achieve the
appropriate account resolution
Case managers are involved from admission with the discharge planning process. The
purpose of discharge planning is: - answerto estimate how long the patient will be in the
hospital, identify the expected outcome of the hospitalization and initiate any special
requirements for services at or after the time of discharge
, The chargemaster is basically a list of services, procedures, room accommodations,
supplies, drugs, tests, etc. typically associated with the billing for services rendered to
patients. Challenges typically associated with the Charge master include: -
answeromission of charges, obsolete or invalid codes, and the omission of required
modifiers
Ultimately, the services provided in the healthcare system are reduced to standard
codes. The primary types of coding systems currently used in healthcare are: -
answerICD-10-CM/ICD-10-PCS; CPT/HCPCS codes
There are four code sets that provide health plans with additional information as they
process claims. Those code sets are: - answercondition codes, occurrence codes,
occurrence span codes and value codes
Each type of service has unique billing rules which come into play during the provision
of service. For the skilled nursing facility, care is covered if which of the following factors
are present: - answerthe patient required skilled services on a daily basis and those
services can only be provided on a inpatient basis in a SNF
DRG's are system of classifying inpatients on the basis of diagnoses, procedures, and
co-morbidities for purposes of payment to hospitals. Each DRG includes: - answera
relative weight which is multiplied by the established base payment rate to calculate the
reimbursement for a specific DRG. for exceptionally costly cases over a set dollar
amount, an outliner payment is added to the calculated payment
PPO networks represent one form of discounting commonly used by commercial
payers. The silent PPO represents: - answera discounting scheme whereby health
plans apply generic PPO rates to discount a provider's claims, even though there is no
contractual arrangement between the silent PPO and the provider
The concept of timely filing of claims is important to providers, payers, and patients.
Thus, providers are required to comply with timely claim filing rules. Which of the
following statements are NOT true about timely filing limitations? - answerpayers will
waive timely filing denials for claims filed over a year from date of service
In what manner do case managers assist revenue cycle staff? - answerproviding
assistance with written appeals to health plans related to utilization and other care
issues
The purpose of case management - answeris to monitor the progression of high
resource consumptive cases to help ensure effective utilization of resources during the
care of the patient and maximize patient outcomes
Case managers are often nurses with specialized training in specific areas... -
answerthey may become certified case managers by taking speciality examinations and
having appropriate credentials and experience
What does EMTALA require hospitals to do? - answerto provide a medical screening
examination and stabilizing treatment to every person presenting at an ED and
requesting medical evaluation or treatment
What is the first critical step for all patients arriving for service, scheduled or
unscheduled? - answerverifying the patient's identification with a combination of two
identifiers from a valid information source
Admission process forms include: - answerconsent to treatment, conditions of
admission, privacy notice, important message from Medicare, advance directives and
medical power of attorney, patient bill of rights
EMTALA prohibits inquires about health care or liability payer information if the inquiry
will delay examination or treatment. What other requirements apply to the Emergency
Department registration work? - answerpatients are initially triaged by medical
personnel and a "quick" registration initiated to allow electronic order entry and
documentation, identification and verification of insurance eligibility and benefits once
the medical screening has been completed, no additional registration may occur until
the patient is stabilized
Typical activities which must be performed when an unscheduled patient arrives for a
service include: - answeridentification of patient in the MPI or initiation of a new MPI
record, insurance verification of eligibility and benefits, managed care screening,
medical necessity screening, price estimation and financial counseling to achieve the
appropriate account resolution
Case managers are involved from admission with the discharge planning process. The
purpose of discharge planning is: - answerto estimate how long the patient will be in the
hospital, identify the expected outcome of the hospitalization and initiate any special
requirements for services at or after the time of discharge
, The chargemaster is basically a list of services, procedures, room accommodations,
supplies, drugs, tests, etc. typically associated with the billing for services rendered to
patients. Challenges typically associated with the Charge master include: -
answeromission of charges, obsolete or invalid codes, and the omission of required
modifiers
Ultimately, the services provided in the healthcare system are reduced to standard
codes. The primary types of coding systems currently used in healthcare are: -
answerICD-10-CM/ICD-10-PCS; CPT/HCPCS codes
There are four code sets that provide health plans with additional information as they
process claims. Those code sets are: - answercondition codes, occurrence codes,
occurrence span codes and value codes
Each type of service has unique billing rules which come into play during the provision
of service. For the skilled nursing facility, care is covered if which of the following factors
are present: - answerthe patient required skilled services on a daily basis and those
services can only be provided on a inpatient basis in a SNF
DRG's are system of classifying inpatients on the basis of diagnoses, procedures, and
co-morbidities for purposes of payment to hospitals. Each DRG includes: - answera
relative weight which is multiplied by the established base payment rate to calculate the
reimbursement for a specific DRG. for exceptionally costly cases over a set dollar
amount, an outliner payment is added to the calculated payment
PPO networks represent one form of discounting commonly used by commercial
payers. The silent PPO represents: - answera discounting scheme whereby health
plans apply generic PPO rates to discount a provider's claims, even though there is no
contractual arrangement between the silent PPO and the provider
The concept of timely filing of claims is important to providers, payers, and patients.
Thus, providers are required to comply with timely claim filing rules. Which of the
following statements are NOT true about timely filing limitations? - answerpayers will
waive timely filing denials for claims filed over a year from date of service
In what manner do case managers assist revenue cycle staff? - answerproviding
assistance with written appeals to health plans related to utilization and other care
issues
The purpose of case management - answeris to monitor the progression of high
resource consumptive cases to help ensure effective utilization of resources during the
care of the patient and maximize patient outcomes
Case managers are often nurses with specialized training in specific areas... -
answerthey may become certified case managers by taking speciality examinations and
having appropriate credentials and experience
