Pre-Service activities - ANSWER-1. Requested service is screened for med necessity, health coverage/benefits verified, preauthorization obtained and estimate to patient oop costs generated within guidelines of NSA and state regulations.
2. Patient notified of financial responsibility including co...
Pre-Service activities - ANSWER-1. Requested service is screened for med necessity,
health coverage/benefits verified, preauthorization obtained and estimate to patient oop
costs generated within guidelines of NSA and state regulations.
2. Patient notified of financial responsibility including copayment and health plan
deductibles, eligibility of financial assistance assessed.
3. Patient is scheduled
4. Encounter record is generated and patient and guarantor info is obtained and
updates as part of preregistration.
5. Cost of the scheduled service identified patients health plan benefits are used to
calculate the price of the services to the patient. - includes deductible, coinsurance and
or copayment amounts.
Time of service - ANSWER-Financial account review is completed prior to patient visit.
Patient arrives at service unit where pre-registration record is activated, consents are
signed, copayments and agreed upon amounts are collected.
Positive identification is completed, and the patient is given an armband with acct
number.
Scheduled preprocessed patients report to designated express arrival desk located in
centralized area upon arrival.
Unscheduled patients - Time of Service - ANSWER-Comprehensive registration and
financial processing is completed at time of service. Mirroring scheduled patients who is
OON with provider furnishing services during their encounter all federal and state
transparency and NSA provisions are followed to provide consent to patient of their
rights
Time of Service steps - ANSWER-Case management and discharge planning are
provided.
Orders are entered.
Results are reported.
Charges are generated.
,Diagnostic and procedural coding is completed.
ONGOING:
Monitor of charges
Managed care resolution
Patient liabilities resolution, as needed.
Ensure health plan requirements and liability calculations change - vet the changes
against fed/state guidelines. Consent and updated estimates are communicated to
patient and health plan.
Post Service - ANSWER-Includes the account activities that occur after the patient is
discharged until the acct reaches zero balance, such as final coding of all services,
preparation and submission of claims, payment processing and balance billing and
resolution.
Best practices recognize all three critical segments of the contemporary revenue cycle.
Each segment includes a series of processes which are specifically designed to ensure
accurate data collection, consistent quality, and a high level of patient satisfaction.
Preservice - patient is scheduled and registered for service. Patients service costs are
calculated.
Time of service - Case mgmt and discharge planing services are provided. Consents
are signed.
Post Service - Bill sent electronically to - ANSWER-
Consumer Experience - ANSWER-Each segment of the revenue cycle interacts
involving patients. The key to success is establishing a clear and ever present focus on
the patient.
Patient Experience - ANSWER-Patients are demanding info and choices.
Regulations are demanding price transparency. For all known charges - even those not
employed by the provider.
Expect quality - health care and financial care.
Health plans care about quality - HCACPS stars is a measure of satisfaction.
With poor scores - Medicare will be reduced.
,Customer Experience - ANSWER-Customer service is paramount.
Empowering front line staff to provide patient focused solutions is basic component of
great patient experience.
Best practice communication strategies, scripting and training are good tactics.
Healthcare Dollars and Sense - ANSWER-HFMA revenue cycle initiatives:
Patients Financial communications best practices
Best practice for price transparency
medical account resolution
Financial Discussions - ANSWER-In ED Setting - no patient financial discussions
should occur before a patient is screened and stabilized, in accordance with local
regulations governing the ed.
Emergency med conditions - ANSWER-If medical screening determines that a patient
has an emergency med condition, the financial discussion should occur during the
discharge process.
For patients who do not have emergency condition following the medical screening,
discussion may occur during registration at bedside or discharge process.
Non-emergency conditions - ANSWER-Outside ED Setting discussions may take place
during registration or discharge process in a location that does not disrupt patient flow.
If a patient consents to financial discussion during a medical encounter to expedite
discharge, best practice supports that choice.
Discussions in advance of service - ANSWER-Use the most appropriate means of
communication for the patient, can occur via outbound contact with the patient, inbound
contact from the patient, or scheduling contact at time of appointment.
Timeliness of discussion - ANSWER-Reasonable attempt must be made to have the
discussion as early as possible, before financial obligation is incurred (service)
, Patients - ANSWER-Patients should be given the opportunity to request a patient
advocate, family member. Or other designee to help them with discussion.
Provision of Care - ANSWER-ED Patients should also be informed that their ability to
pay will not interfere with treatment of any emergency medical conditions.
Uninsured patients - should be informed that the goal of collecting info. Is to identify
paying solutions or financial assistance options that may aid them with their financial
obligations.
OON - must be provided disclosures, notifications and consent according to fed/state
regulations.
Prior balances - ANSWER-Across all lines - it is important to have clear policies on how
to interact with patients with prior balances. Providers should have clear definitions of
elective and non-elective procedures. Policies should be made available to public.
Patients should be informed for non-elective surgeries of that their ability to resolve prior
balances with not affect provision of care.
Prior to elective - patient should do good faith estimate within state/fed regulations to
make payment arrangements.
Annual Financial Training Programs - ANSWER-Must include:
Patient financial communications specific to staff role
Financial assistance policies
Available patient financing options.
Alternative solutions for the uninsured
Standard language to be used
Laws and regulations.
Annual observation - ANSWER-Observation, monitoring and tracking of results make up
the process of compliance evaluation required to document compliance.
Evaluation of technology - ANSWER-Ensuring that:
Insurance eligibility for current services
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