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final exam review

MOP 130

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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