Why does the financial counselor need pricing for services? - ANSWERS-To
calculate the patient's financial responsibility
What type of provider bills third-party payers using CMS 1500 form - ANSWERS-
Hospital-based mammography centers
How are disputes with nongovernmental payers resolved? - ANSWERS-Appeal
conditions specified in the individual payer's contract
The important message from Medicare provides beneficiaries with information
concerning what? - ANSWERS-Right to appeal a discharge decision if the patient
disagrees with the services
Why do managed care plans have agreements with hospitals, physicians, and
other healthcare providers to offer a range of services to plan members? -
ANSWERS-To improve access to quality healthcare
If a patient remains an inpatient of an SNF (skilled nursing facility for more than
30 days, what is the SNF permitted to do? - ANSWERS-Submit interim bills to the
Medicare program.
,90. MSP (Medicare Secondary Payer) rules allow providers to bill Medicare for
liability claims after what happens? - ANSWERS-120 days passes, but the claim
then be withdrawn from the liability carrier
What data are required to establish a new MPI entry? - ANSWERS-The patient's
full legal name, date of birth, and sex
What should the provider do if both of the patient's insurance plans pay as
primary? - ANSWERS-Determine the correct payer and notify the incorrect payer
of the processing error
What do EMTALA regulations require on-call physicians to do? - ANSWERS-
Personally appear in the emergency department and attend to the patient within
a reasonable time
At the end of each shift, what must happen to cash, checks, and credit card
transaction documents? - ANSWERS-They must be balanced
What will cause a CMS 1500 claim to be rejected? - ANSWERS-The provider is
billing with a future date of service
Under Medicare regulations, which of the following is not included on a valid
physician's order for services? - ANSWERS-The cost of the test
, how are HCPCS codes and the appropriate modifiers used? - ANSWERS-To report
the level 1, 2, or 3 code that correctly describes the service provided
If a Medicare patient is admitted on Friday, what services fall within the three-day
DRG window rule? - ANSWERS-Diagnostic and clinically-related non-diagnostic
charges provided on the Tuesday, Wednesday, Thursday, and Friday before
admission
What is a benefit of pre-registering patient's for service? - ANSWERS-Patient
arrival processing is expedited, reducing wait times and delays
What is a characteristic of a managed contracting methodology? - ANSWERS-
Prospectively set rates for inpatient and outpatient services
What do the MSP disability rules require? - ANSWERS-That the patient's spouse's
employer must have less than 20 employees in the group health plan
what organization originated the concept of insuring prepaid health care services?
- ANSWERS-Blue Cross and blue Shield
What is true about screening a beneficiary for possible MSP situations? -
ANSWERS-It is acceptable to complete the screening form after the patient has
completed the registration process and been sent to the service department
The benefits of buying summaries with Stuvia:
Guaranteed quality through customer reviews
Stuvia customers have reviewed more than 700,000 summaries. This how you know that you are buying the best documents.
Quick and easy check-out
You can quickly pay through credit card or Stuvia-credit for the summaries. There is no membership needed.
Focus on what matters
Your fellow students write the study notes themselves, which is why the documents are always reliable and up-to-date. This ensures you quickly get to the core!
Frequently asked questions
What do I get when I buy this document?
You get a PDF, available immediately after your purchase. The purchased document is accessible anytime, anywhere and indefinitely through your profile.
Satisfaction guarantee: how does it work?
Our satisfaction guarantee ensures that you always find a study document that suits you well. You fill out a form, and our customer service team takes care of the rest.
Who am I buying these notes from?
Stuvia is a marketplace, so you are not buying this document from us, but from seller Teacher101. Stuvia facilitates payment to the seller.
Will I be stuck with a subscription?
No, you only buy these notes for $17.99. You're not tied to anything after your purchase.