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CHAM Arrival - Revenue Cycle (2024) Questions With 100% Correct!!
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CHAM Arrival - Revenue Cycle (2024) Questions With 100% Correct!!
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Name: Score:79 Multiple choice questions
Definition 1 of 79
Insurance group name [situational] Insurance group number [situational]treatment
authorization code [situational] document control number [situational] employer name
[situational] diagnosis and procedure code qualifier principle diagnosis code other diagnosis
codesadmitting diagnosis patient's reason for visit [situational] principal procedure code and
date [situational] other procedure code and date [situational] attending provider name and
identifiers (including NPI) [situational] operating provider name and identifiers [situational]
remarks [situational] code-code field [situational
Case Management
Team Nursing
Primary Nursing
Total Patient Care
Definition 2 of 79
have not received the claim. Ask the person to whom you are speaking to verify the claim billing
address. Even when the claim is sent electronically, carriers will deny receipt of claim. Although
electronic billing firms send us confirmation of receipt, the carriers claim they do not have a
system to track incoming claims. However, the confirmation we receive through National
Association of Insurance Commissioners is sufficient for us to argue for prompt payment. If the
insurance carrier continues to delay the payment without reasonable cause, notify your manager.
If necessary, the account will be turned over to a collection agency or legal department to
pursue.
The primary purpose of the ICD classification of morbidity and mortality information is for
The case management team also works directly with the finance department to
The record facilitates:
The number one delay tactic used by an insurance company is that they
,Definition 3 of 79
streamline the revenue cycle, improve communication with payers and institute operational
efficiency and ultimately a more profitable bottom line.
The case management team also works directly with the finance department to
The following will guide you in making proper documentation and corrections:
Case Management was introduced in the 1980's in order to control costs by
Due to meaningful use requirements a vast majority of hospitals have transitioned to
,Term 4 of 79
Basic principles of documentation which apply to all health care services and levels of care:
have not received the claim. Ask the person to whom you are speaking to verify the claim
billing address. Even when the claim is sent electronically, carriers will deny receipt of
claim. Although electronic billing firms send us confirmation of receipt, the carriers claim
they do not have a system to track incoming claims. However, the confirmation we receive
through National Association of Insurance Commissioners is sufficient for us to argue for
prompt payment. If the insurance carrier continues to delay the payment without
reasonable cause, notify your manager. If necessary, the account will be turned over to a
collection agency or legal department to pursue.
Record should be complete, accurate and legible The documentation of each patient
encounter should include the following: Patient name, age, other demographic information
Reason for the encounter, relevant history, physical finding including health risks such as
obesity, hypertension etc., all diagnostic tests and results. Assessment, clinical impression
and diagnosis o Medical necessity for tests, procedures, other care ordered Patient's
response to therapy/care provided; good or bad Changes in treatment plan and/or revision
of diagnoses Plan of care and any risks associated with care plan. *Name of person
documenting, and the date and time of assessment
The hospital is required to maintain a medical record on every patient under state licensure
laws, Joint Commission standards, and conditions of participation in federal reimbursement
programs. The medical record is a written compilation of information generated during the
course of a patient's treatment for illness and or health maintenance. It documents a variety
of data including personal, social, financial, and medical information. The required content
may vary from state to state. Federal regulations (Medicare/Medicaid) state that the
medical record must be retained for a minimum of five years and otherwise accordance
with state law.
One phone call every month is not an effective method to use in obtaining a payment.
Thorough documentation is critical. Not only for your own records, but is that others may
understand what actions have been taken or are expected. Do not rely on memory or
cryptic notes. One rule of thumb to remember with documentation is that if it is not
documented, it did not happen. Be sure to include first and last name of the person you are
speaking to. Remember in a large company there may be 5 women named Susan.
, Term 5 of 79
Notice Law- Passed in March of 2015 requires hospitals to provide observation patients who have
a outpatient observation stay of more than 24 hours an adequate oral and written notification
within
48 hours after the patient is admitted.
36 hours after being placed in observation.
24 hours before the patient is discharged.
only if the patient requests it.
Definition 6 of 79
Uniform Bill (UB04) is the recognized bill form for hospitals and other institutional healthcare
providers.
Many functions happen in billing and dependent upon the accuracy of the front Patient
Access and middle Case Management/HIM, this determines how much effort it will take to
Inpatient admissions will generally be payable under Part A if the admitting practitioner
expected the patient to require a hospital stay that crossed two midnights and the medical
record supports that
In an effort to simplify healthcare billing in America and to develop one standard, a
nationally accepted billing form was created in 1982. It has been replaced and now the
Recent CMS regulatory changes require a more proactive collaboration between patient
access, case management, utilization review and discharge planning to coordinate
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