CHAM Arrival - Revenue Cycle questions with 100% correct
answers(GUARANTEED SUCCESS)
Terms in this set (82)
several departments with numerous responsibilities.
Revenue Cycle consists of
Department responsibilities and names vary by organization.
The key to a strong revenue cycle clean claim.
is a
Patient Access is responsible for 60% of the claims fields on a UB04.
over
In 1975, the American Hospital National Uniform billing committee (NUBC).
Association brought together all
the national payer and provider
organizations and developed
the
In an effort to simplify healthcare Uniform Bill (UB04) is the recognized bill form for hospitals
billing in America and to develop and other institutional healthcare providers.
one standard, a nationally
accepted billing form was
created in 1982. It has been
replaced and now the
The UB04 document is made up form locators.
of 81 different data fields,
called
type of information input into the field. Recent changes to the form
Each form locator name describes include an
the increase in filed size, additional fields being allocated, and labels
changed to better explain the purpose of the form locator.
Provider and patient information (Form locators 1-41) Services provided
Data elements necessary for
to the
accurate billing include:
patient (Form locators 42-49) Patient's insurance information (Form
Locators 50-65)
Diagnosis, procedure, and physician information (Form Locators 66-81)
, 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
Required fields are: 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
Insurance group name [situational] Insurance group number
[situational]treatment authorization code [situational]
document control number [situational] employer
name [situational] diagnosis and procedure code qualifier
Case Management
principle diagnosis code other diagnosis codesadmitting
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 improving quality and manage use of hospital inpatient resources.
in the 1980's in order to control
costs by
There is a renewed interest in healthcare delivery.
case
management, as the hospital C Suite
is
beginning to recognize its unique
role as a bridge between the
, clinical and financial realms of
An interdisciplinary case all admissions and observation stays in the hospital are
management team (which may justified, documentation supports the appropriate level of care
consist of utilization review and and payment for the hospital, roadblock from timely discharge
discharge planning functions work form the facility removed and that condition of care across the
directly with healthcare continuum improves quality, patient satisfaction avoiding
providers to ensure unnecessary readmissions.
The case management team also streamline the revenue cycle, improve communication with payers
works directly with the finance and institute operational efficiency and ultimately a more
department to profitable bottom line.
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
Case Management performs five clinical
major functions to the revenue denials or denied days. Assist with the discharge process and
cycle team: 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-* Clinical Documentation Improvement) to
maximize compliance and reimbursement.
Recent CMS regulatory changes admission, in house care, discharge and post-acute care services.
require a more proactive
collaboration between patient
access, case management,
utilization review and discharge
planning to coordinate
2 Midnight Rule- On July 1, 2015, Medicare Part A.
CMS
released proposed updates to the
"Two- Midnight" rule regarding
when inpatient admissions are
appropriate for payment under
answers(GUARANTEED SUCCESS)
Terms in this set (82)
several departments with numerous responsibilities.
Revenue Cycle consists of
Department responsibilities and names vary by organization.
The key to a strong revenue cycle clean claim.
is a
Patient Access is responsible for 60% of the claims fields on a UB04.
over
In 1975, the American Hospital National Uniform billing committee (NUBC).
Association brought together all
the national payer and provider
organizations and developed
the
In an effort to simplify healthcare Uniform Bill (UB04) is the recognized bill form for hospitals
billing in America and to develop and other institutional healthcare providers.
one standard, a nationally
accepted billing form was
created in 1982. It has been
replaced and now the
The UB04 document is made up form locators.
of 81 different data fields,
called
type of information input into the field. Recent changes to the form
Each form locator name describes include an
the increase in filed size, additional fields being allocated, and labels
changed to better explain the purpose of the form locator.
Provider and patient information (Form locators 1-41) Services provided
Data elements necessary for
to the
accurate billing include:
patient (Form locators 42-49) Patient's insurance information (Form
Locators 50-65)
Diagnosis, procedure, and physician information (Form Locators 66-81)
, 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
Required fields are: 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
Insurance group name [situational] Insurance group number
[situational]treatment authorization code [situational]
document control number [situational] employer
name [situational] diagnosis and procedure code qualifier
Case Management
principle diagnosis code other diagnosis codesadmitting
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 improving quality and manage use of hospital inpatient resources.
in the 1980's in order to control
costs by
There is a renewed interest in healthcare delivery.
case
management, as the hospital C Suite
is
beginning to recognize its unique
role as a bridge between the
, clinical and financial realms of
An interdisciplinary case all admissions and observation stays in the hospital are
management team (which may justified, documentation supports the appropriate level of care
consist of utilization review and and payment for the hospital, roadblock from timely discharge
discharge planning functions work form the facility removed and that condition of care across the
directly with healthcare continuum improves quality, patient satisfaction avoiding
providers to ensure unnecessary readmissions.
The case management team also streamline the revenue cycle, improve communication with payers
works directly with the finance and institute operational efficiency and ultimately a more
department to profitable bottom line.
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
Case Management performs five clinical
major functions to the revenue denials or denied days. Assist with the discharge process and
cycle team: 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-* Clinical Documentation Improvement) to
maximize compliance and reimbursement.
Recent CMS regulatory changes admission, in house care, discharge and post-acute care services.
require a more proactive
collaboration between patient
access, case management,
utilization review and discharge
planning to coordinate
2 Midnight Rule- On July 1, 2015, Medicare Part A.
CMS
released proposed updates to the
"Two- Midnight" rule regarding
when inpatient admissions are
appropriate for payment under
