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
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Through what document does a hospital establish compliance standards? -
ANSWER- code of conduct
What is the purpose OIG work plant? - ANSWER- Identify 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? - ANSWER- Non-diagnostic service provided on Tuesday
through Friday
What does a modifier allow a provider to do? - ANSWER- Report 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 - ANSWER- They must be billed
separately to the part B Carrier
what is a recurring or series registration? - ANSWER- One registration record is
created for multiple days of service
What are nonemergency patients who come for service without prior notification
to the provider called? - ANSWER- Unscheduled patients
Which of the following statement apply to the observation patient type? -
ANSWER- It is used to evaluate the need for an inpatient admission
which services are hospice programs required to provide around the clock
patient - ANSWER- Physician, Nursing, Pharmacy
,Scheduler instructions are used to prompt the scheduler to do what? - ANSWER-
Complete 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? - ANSWER- Procedure time
Medicare guidelines require that when a test is ordered for a LCD or NCD exists,
the information provided on the order must include: - ANSWER- Documentation
of the medical necessity for the test
What is the advantage of a pre-registration program - ANSWER- It reduces
processing times at the time of service
What date are required to establish a new MPI(Master patient Index) entry -
ANSWER- The responsible party's full legal name, date of birth, and social
security number
Which of the following statements is true about third-party payments? -
ANSWER- The 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 - ANSWER- stop loss
what documentation must a primary care physician send to HMO patient to
authorize a visit to a specialist for additional testing or care? - ANSWER- Referral
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? - ANSWER- Medical screening and stabilizing treatment
Which of the following is a step in the discharge process? - ANSWER- Have 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? - ANSWER- To 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? - ANSWER- $100.00
When is a patient considered to be medically indigent? - ANSWER- The patient's
outstanding medical bills exceed a defined dollar amount or percentage of
assets.
What patient assets are considered in the financial assistance application? -
ANSWER- Sources of readily available funds , vehicles, campers, boats and
saving accounts
If the patient cannot agree to payment arrangements, What is the next option? -
ANSWER- Warn the patient that unpaid accounts are placed with collection
agencies for further processing
What core financial activities are resolved within patient access? - ANSWER-
scheduling , pre-registration, insurance verification and managed care
processing
What is an unscheduled direct admission? - ANSWER- A patient who arrives at
the hospital via ambulance for treatment in the emergency department
When is it not appropriate to use observation status? - ANSWER- As a substitute
for an inpatient admission
Patients who require periodic skilled nursing or therapeutic care receive services
from what type of program? - ANSWER- Home health agency
Every patient who is new to the healthcare provider must be offered what? -
ANSWER- A printed copy of the provider privacy notice
Which of the following statements apples to self insured insurance plans? -
ANSWER- The employer provides a traditional HMO health plan
In addition to the member's identification number, what information is recorded in
a 270 transaction - ANSWER- Name
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