CHAM Arrival - Revenue Cycle
Exam | 82 Questions with
Answers
Revenue Cycle consists of - -several departments with numerous
responsibilities. Department responsibilities and names vary by organization.
- The key to a strong revenue cycle is a - -clean claim.
- Patient Access is responsible for over - -60% of the claims fields on a
UB04.
- In 1975, the American Hospital Association brought together all the
national payer and provider organizations and developed the - -National
Uniform billing committee (NUBC).
- In an effort to simplify healthcare billing in America and to develop one
standard, a nationally accepted billing form was created in 1982. It has been
replaced and now the - -Uniform Bill (UB04) is the recognized bill form for
hospitals and other institutional healthcare providers.
- The UB04 document is made up of 81 different data fields, called - -form
locators.
- Each form locator name describes the - -type of information input into the
field. Recent changes to the form include an increase in filed size, additional
fields being allocated, and labels changed to better explain the purpose of
the form locator.
- Data elements necessary for accurate billing include: - -*Provider and
patient information (Form locators 1-41) *Services provided to the patient
(Form locators 42-49) *Patient's insurance information (Form Locators 50-65)
*Diagnosis, procedure, and physician information (Form Locators 66-81)
- Required fields are: - -provider name, address and telephone number &
pay to name, address[situational] *patient control number *medical/health
record number [situational] *Other provider ID [situational] *Insured's name
*Patient's relationship to insured *Insured's unique ID (certificate, social
security number, HI Claim/ID number) *type of bill *federal tax number
*statement covers period (from/through dates) *patient name and address
*date of birth *sex *admission date (inpatients) *admission type (inpatients)
*patient status *conditions codes [situational] *occurrence code and
, data[situational] occurrence span code (inpatients) *occurrence span dates
(inpatients) *value codes and amounts *revenue code *HCPCS/rate/HIPPS
rates codes *service date *units of service *total charges *payer
identification (name) *health plan ID *release of information certification
indicator *prior payments [situational] *National Provider ID
- Case Management - -*Insurance group name [situational] *Insurance
group number [situational]*treatment authorization code [situational]
*document control number [situational] *employer name [situational]
*diagnosis and procedure code qualifier *principle diagnosis code *other
diagnosis codes*admitting diagnosis *patient's reason for visit [situational]
*principal procedure code and date [situational] *other procedure code and
date [situational] *attending provider name and identifiers (including NPI)
[situational] *operating provider name and identifiers [situational] *remarks
[situational] *code-code field [situational
- Case Management was introduced in the 1980's in order to control costs by
- -improving quality and manage use of hospital inpatient resources.
- There is a renewed interest in case management, as the hospital C Suite is
beginning to recognize its unique role as a bridge between the clinical and
financial realms of - -healthcare delivery.
- An interdisciplinary case management team (which may consist of
utilization review and discharge planning functions work directly with
healthcare providers to ensure - -all admissions and observation stays in the
hospital are justified, documentation supports the appropriate level of care
and payment for the hospital, roadblock from timely discharge form the
facility removed and that condition of care across the continuum improves
quality, patient satisfaction avoiding unnecessary readmissions.
- The case management team also works directly with the finance
department to - -streamline the revenue cycle, improve communication with
payers and institute operational efficiency and ultimately a more profitable
bottom line.
- Case Management performs five major functions to the revenue cycle
team: - -*Obtain pre-authorizations and precertification approve from
insurance carriers and payers *Reduce unnecessary admission and
effectively manage length of stay. Inherently, they manage medical
necessity which results in reduction of clinical denials or denied days. *Assist
with the discharge process and may assist with CMS regulatory requirements
surrounding discharge. i.e. ( IMM, 2 Midnight Rule, Notice Law) *Act as a
liaison between providers and the revenue cycle departments (HIM) to
ensure accurate, complete documentation for compliant coding and billing
processes by providing a careful review of physician documentation (CDI-*
Exam | 82 Questions with
Answers
Revenue Cycle consists of - -several departments with numerous
responsibilities. Department responsibilities and names vary by organization.
- The key to a strong revenue cycle is a - -clean claim.
- Patient Access is responsible for over - -60% of the claims fields on a
UB04.
- In 1975, the American Hospital Association brought together all the
national payer and provider organizations and developed the - -National
Uniform billing committee (NUBC).
- In an effort to simplify healthcare billing in America and to develop one
standard, a nationally accepted billing form was created in 1982. It has been
replaced and now the - -Uniform Bill (UB04) is the recognized bill form for
hospitals and other institutional healthcare providers.
- The UB04 document is made up of 81 different data fields, called - -form
locators.
- Each form locator name describes the - -type of information input into the
field. Recent changes to the form include an increase in filed size, additional
fields being allocated, and labels changed to better explain the purpose of
the form locator.
- Data elements necessary for accurate billing include: - -*Provider and
patient information (Form locators 1-41) *Services provided to the patient
(Form locators 42-49) *Patient's insurance information (Form Locators 50-65)
*Diagnosis, procedure, and physician information (Form Locators 66-81)
- Required fields are: - -provider name, address and telephone number &
pay to name, address[situational] *patient control number *medical/health
record number [situational] *Other provider ID [situational] *Insured's name
*Patient's relationship to insured *Insured's unique ID (certificate, social
security number, HI Claim/ID number) *type of bill *federal tax number
*statement covers period (from/through dates) *patient name and address
*date of birth *sex *admission date (inpatients) *admission type (inpatients)
*patient status *conditions codes [situational] *occurrence code and
, data[situational] occurrence span code (inpatients) *occurrence span dates
(inpatients) *value codes and amounts *revenue code *HCPCS/rate/HIPPS
rates codes *service date *units of service *total charges *payer
identification (name) *health plan ID *release of information certification
indicator *prior payments [situational] *National Provider ID
- Case Management - -*Insurance group name [situational] *Insurance
group number [situational]*treatment authorization code [situational]
*document control number [situational] *employer name [situational]
*diagnosis and procedure code qualifier *principle diagnosis code *other
diagnosis codes*admitting diagnosis *patient's reason for visit [situational]
*principal procedure code and date [situational] *other procedure code and
date [situational] *attending provider name and identifiers (including NPI)
[situational] *operating provider name and identifiers [situational] *remarks
[situational] *code-code field [situational
- Case Management was introduced in the 1980's in order to control costs by
- -improving quality and manage use of hospital inpatient resources.
- There is a renewed interest in case management, as the hospital C Suite is
beginning to recognize its unique role as a bridge between the clinical and
financial realms of - -healthcare delivery.
- An interdisciplinary case management team (which may consist of
utilization review and discharge planning functions work directly with
healthcare providers to ensure - -all admissions and observation stays in the
hospital are justified, documentation supports the appropriate level of care
and payment for the hospital, roadblock from timely discharge form the
facility removed and that condition of care across the continuum improves
quality, patient satisfaction avoiding unnecessary readmissions.
- The case management team also works directly with the finance
department to - -streamline the revenue cycle, improve communication with
payers and institute operational efficiency and ultimately a more profitable
bottom line.
- Case Management performs five major functions to the revenue cycle
team: - -*Obtain pre-authorizations and precertification approve from
insurance carriers and payers *Reduce unnecessary admission and
effectively manage length of stay. Inherently, they manage medical
necessity which results in reduction of clinical denials or denied days. *Assist
with the discharge process and may assist with CMS regulatory requirements
surrounding discharge. i.e. ( IMM, 2 Midnight Rule, Notice Law) *Act as a
liaison between providers and the revenue cycle departments (HIM) to
ensure accurate, complete documentation for compliant coding and billing
processes by providing a careful review of physician documentation (CDI-*
