Through what document does a hospital establish compliance standards?
code of conduct
What is the purpose OIG work plant?
Identify Acceptable compliance programs in various provider setting
If a Medicare patient is admitted on Friday, what services fall within the three-day DRG wind...
HFMA CRCR
Through what document does a hospital establish compliance standards? correct answercode of conduct
What is the purpose OIG work plant? correct answerIdentify Acceptable compliance programs in various
provider setting
If a Medicare patient is admitted on Friday, what services fall within the three-day DRG window rule? correct answerNon-diagnostic service provided on Tuesday through Friday
What does a modifier allow a provider to do? correct answerReport a specific circumstance that affected
a procedure or service without changing the code or its definition
IF outpatient diagnostic services are provided within three days of the admission of a Medicare beneficiary to an IPPS (Inpatient Prospective Payment System) hospital, what must happen to these charges correct answerThey must be billed separately to the part B Carrier
what is a recurring or series registration? correct answerOne registration record is created for multiple days of service
What are nonemergency patients who come for service without prior notification to the provider called?
correct answerUnscheduled patients
Which of the following statement apply to the observation patient type? correct answerIt is used to evaluate the need for an inpatient admission
which services are hospice programs required to provide around the clock patient correct answerPhysician, Nursing, Pharmacy Scheduler instructions are used to prompt the scheduler to do what? correct answerComplete the scheduling process correctly based on service requeste
The Time needed to prepare the patient before service is the difference between the patients arrival time and which of the following? correct answerProcedure time
Medicare guidelines require that when a test is ordered for a LCD or NCD exists, the information provided on the order must include: correct answerDocumentation of the medical necessity for the test
What is the advantage of a pre-registration program correct answerIt reduces processing times at the time of service
What date are required to establish a new MPI(Master patient Index) entry correct answerThe responsible party's full legal name, date of birth, and social security number
Which of the following statements is true about third-party payments? correct answerThe payments are
received by the provider from the payer responsible for reimbursing the provider for the patient's covered services.
Which provision protects the patient from medical expenses that exceed the pre-set level correct answerstop loss
what documentation must a primary care physician send to HMO patient to authorize a visit to a specialist for additional testing or care? correct answerReferral
Under EMTALA (Emergency Medical Treatment and Labor Act) regulations, the provider may not ask about a patient's insurance information if it would delay what? correct answerMedical screening and stabilizing treatment
Which of the following is a step in the discharge process? correct answerHave a case management service complete the discharge plan The hospital has a APC based contract for the payment of outpatient services. Total anticipated charges for the visit are $2,380. The approved APC payment rate is $780. Where will the patients benefit package be applied? correct answerTo the approved APC payment rate
A patient has met the $200 individual deductible and $900 of the $1000 co-insurance responsibility. The co-insurance rate is 20%. The estimated insurance plan responsibility is $1975.00. What amount of coinsurance is due from the patient? correct answer$100.00
When is a patient considered to be medically indigent? correct answerThe patient's outstanding medical
bills exceed a defined dollar amount or percentage of assets.
What patient assets are considered in the financial assistance application? correct answerSources of readily available funds , vehicles, campers, boats and saving accounts
If the patient cannot agree to payment arrangements, What is the next option? correct answerWarn the
patient that unpaid accounts are placed with collection agencies for further processing
What core financial activities are resolved within patient access? correct answerscheduling , pre-
registration, insurance verification and managed care processing
What is an unscheduled direct admission? correct answerA patient who arrives at the hospital via ambulance for treatment in the emergency department
When is it not appropriate to use observation status? correct answerAs a substitute for an inpatient admission
Patients who require periodic skilled nursing or therapeutic care receive services from what type of program? correct answerHome health agency
Every patient who is new to the healthcare provider must be offered what? correct answerA printed copy of the provider privacy notice
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