Overall aggregate payments made to a hospice are subject to a computed "cap amount" calculated by - Answer- The Medicare Administrative Contractor (MAC) at the end of the hospice cap period
Which of the following is required for participation in Medicaid - Answer- Meet Income and Assets Requirem...
CRCR Certification exam Overall aggregate payments made to a hospice are subject to a computed "cap amount" calculated by - Answer- The Medicare Administrative Contractor (MAC) at the end of the hospice cap period
Which of the following is required for participation in Medicaid - Answer- Meet Income and Assets Requirements
In choosing a setting for patient financial discussions, organizations should first and foremost - Answer- Respect the patients privacy
A nightly room charge will be incorrect if the patient's - Answer- Transfer from ICU (intensive care unit) to the Medical/Surgical
floor is not reflected in the registration system
The Affordable Care Act legislated the development of Health Insurance Exchanges, where individuals and small businesses can - Answer- Purchase qualified health benefit
plans regardless of insured's
health status
A portion of the accounts receivable inventory which has NOT qualified for billing includes: - Answer- Charitable pledges
What is required for the UB-04/837-I, used by Rural Health Clinics to generate payment from Medicare? - Answer- Revenue codes
This directive was developed to promote and ensure healthcare quality and value and also to protect consumers and workers in the healthcare system. This directive is called - Answer- Patient bill of rights
The activity which results in the accurate recording of patient bed and level of care assessment, patient transfer and patient discharge status on a real-time basis is known as - Answer- Case management
Which statement is an EMTALA (Emergency Medical Treatment and Active Labor Act) violation? - Answer- Registration staff may routinely contact managed are plans for prior
authorizations before the patient is seen by the on-duty physician
HIPAA had adopted Employer Identification Numbers (EIN) to be used in standard transactions to identify the employer of an individual described in a transaction EIN's are
assigned by - Answer- The Internal Revenue Service
Checks received through mail, cash received through mail, and lock box are all examples of - Answer- Control points for cash posting What are some core elements if a board-approved financial assistance policy? - Answer- Eligibility, application process, and nonpayment collection activities
A recurring/series registration is characterized by - Answer- The creation of one registration record for multiple days of service
With the advent of the Affordable Care Act Health Insurance Marketplaces and the expansion of Medicaid in some states, it is more important than ever for hospitals to - Answer- Assist patients in understanding their insurance coverage and their financial obligation
The purpose of a financial report is to: - Answer- Present financial information to decision makers
Patient financial communications best practices produce communications that are - Answer- Consistent, clear and transparent
Medicare has established guidelines called the Local Coverage Determinations (LCD) and National Coverage Determinations (NCD) that establish - Answer- What services or
healthcare items are covered under Medicare
Any provider that has filed a timely cost report may appeal an adverse final decision received from the Medicare Administrative Contractor (MAC). This appeal may be filed with - Answer- The Provider Reimbursement Review Board
Concurrent review and discharge planning - Answer- Occurs during service
Duplicate payments occur: - Answer- When providers re-bill claims based on nonpayment from the initial bill submission
An individual enrolled in Medicare who is dissatisfied with the government's claim determination is entitled to reconsideration of the decision. This type of appeal is known as - Answer- A beneficiary appeal
Insurance verification results in which of the following - Answer- The accurate identification of the patient's eligibility and benefits
The Medicare fee-for service appeal process for both beneficiaries and providers includes all of the following levels EXCEPT: - Answer- Judicial review by a federal district court
Under EMTALA (Emergency Medical Treatment and Labor Act) regulations, the providermay not ask about a patient's insurance information if it would delay what? - Answer- Medical screening and stabilizing treatment Ambulance services are billed directly to the health plan for - Answer- Services provided
before a patient is admitted and for ambulance rides arranged to pick up the patient from the hospital after discharge to take him/her home or to another facility
Key performance indicators (KPIs) set standards for accounts receivables (A/R) and - Answer- Provide a method of measuring the collection and control of A/R
he patient discharge process begins when - Answer- The physician writes the discharge
orders
The nightly room charge will be incorrect if the patient's - Answer- Transfer from ICU to the Medical/Surgical floor is not reflected in the registration system.
The soft cost of a dissatisfied customer is - Answer- The customer passing on info about their negative experience to potential pts or through social media channels
An advantage of a pre-registration program is - Answer- The opportunity to reduce the corporate compliance failures within the registration process
It is important to have high registration quality standards because - Answer- Inaccurate or incomplete patient data will delay payment or cause denials
Telemed seeks to improve a patient's health by - Answer- Permitting 2-way real time interactive communication between the patient and the clinical professional
Any healthcare insurance plan that provides or ensures comprehensive health maintenance and treatment services for an enrolled group of persons based on a monthly fee is known as a - Answer- HMO
Identifying the patient, in the MPI, creating the registration record, completing medical necessity screening, determining insurance eligibility and benefits resolving managed care, requirements and completing financial education/resolution are all - Answer- The data collection steps for scheduling and pre-registering a patient
Medicare Part B has an annual deductible, and the beneficiary is responsible for - Answer- A co-insurance payment for all Part B covered services
The standard claim form used for billing by hospitals, nursing facilities, and other inpatient - Answer- UB-04
Charges are the basis for - Answer- Separation of fiscal responsibilities between the patient and the health plan
All of the following are forms of hospital payment contracting EXCEPT - Answer- Contracted Rebating
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