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then be withdrawn from the liability carrier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
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