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final exam review
MOP 130
| Question | Answer |
|---|---|
| Acute care | A facility that provides medical care and treatment to patients who require care for their acute condition, illness, or injury. |
| Encounter form | a listing of services and procedures for collecting charges for a patient's visit. |
| inpatient | a patient that requires a minimum 24 hour stay |
| outpatient | patient stays in the hospital for less than 24 hours |
| observation care | when patients need to be monitor closely to determine discharge status. |
| referring physician | The physician who "refers" the patient for admission. |
| assignment of benefits | A consent for any benefits or payments for services will be snet directly to the facility. |
| advance beneficiary notice | consent that identifies services not covered by patient's insurance in which they will be responsible for payment. |
| charge capturing | the gathering of charges and charge documents from all departments for billing purposes. |
| facility charge | a charge for sources use during a patient's stay. |
| releases of medical records form | A consent to release medical information to third party payer. |
| Emergency Medical Treatment Act | states that facilities are obligated to provide emergency medical access to all, regardless of their ability to pay. |
| Social Security Act 1965 | provides health care benefits to the elderly and low income population. |
| Hill-Burton ACT | it provides funding for hospital constructions. |
| COBRA | the ability to continue health Insurance coverage from your previous employer for your 90 day provisionary period of your new employer. |
| patient financial policy | expectation of payment due at the time of service, collection process, and statement that responsibility lies with the patient. |
| Medicare part A | covers inpatient hospital stays |
| Medicare part B | covers outpatient visits |
| CDM | Charge Description Master |
| RA | Remittance Advice |
| EOB | Explanation Of Benefits |
| SNF | Skill Nursing Facility |
| when it is acceptable to code for signs and symptoms ? | Diagnosis has not been establish by provider in the outpatient . |
| who performs audits and investigates fraudulent activities to protect the integrity of the Medicare and Medicaid programs? | (OIG) Office of inspector general |
| who oversees the Medicare and Medicaid programs for the federal government? | (CMS) Centers for Medicare and Medicaid Services |
| what is DHHS responsible for ? | Their responsible for controlling Health care cost |
| What does the NCQA known for ? | providing guidelines on how a facility selects providers |
| what is hospital size measure by? | bed count |
| when a document is charged in an EHR , the original documentation is ___________. | Hidden |
| what should an insurance and coding specialist do when checking for completion of a new patient's registration form? | check demographics are completed, make sure registration forms is sign and dated , make sure the patients name matches card. |
| what is the purpose of a utilization review department? | to make sure all health services provided to a patient are medically necessary. |
| when is the first contact with the patient made in the hospital revenue cycle? | during scheduling/appointments |
| what is a hospital revenue cycle ? | the process or cycle of managing claims, payments, and revenue . |
Created by:
mariaparra
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