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Ensemble CRCR Study
| Question | Answer |
|---|---|
| What document does a hospital establish compliance standards | Code of Conduct |
| To communicate issues that will be reviewed during the year for compliance with Medicare Regulations is the purpose of what work plan | OIG |
| If a patient is admitted on Friday what services fall with the three day DRG window rule | Diagnostic services and related charges on Wed, Thurs or Friday prior to admission |
| What is used to report a specific circumstance that affected a procedure or service without changing the code or its definition | Modifier |
| What does IPPS stand for | Inpatient Prospective Payment System |
| What does OIG stand for | Office of Inspector General |
| If outpatient diagnostic services are provided three days before admission of a medicare pt to an IPPS hospital what must happen | Services must be combined with the inpatient charges and paid under MS-DRG system |
| Who reviews Medicare payments for beneficiaries who have other insurance and assess the effectiveness of procedures to prevent inappropriate Medicare Payments | The OIG |
| One registration record is created for multiple days of service is called | Recurring or Series Registration |
| Scheduling Instructions prompt the scheduler to do what | Complete the schedule based on service requested |
| Advantage of Pre registration | To reduce processing at time of service |
| Medicare guidelines require that when a test is ordered when LCD or NCD exists, The order must include what | Documentation of Medical necessity for test |
| What info is required to establish a new MPI entry | Patients Full Name, date of birth, sex |
| Payments are received by the provider from the payor responsible for reimbursing the provider for the patients coverage is an example of third party payments-True or False | True |
| Mother and Father cover the 16 year old child. Both parents cover the child and the insurance plan uses the birthday rule. Moms birthday is 1/25/68 Dads Birthday is 7/5/1966. Which policy is primary.Mom or Dad | Mom |
| What HIPPA Transaction set provides electronic processing of Insurance Verification Response and Requests | 270-271 set |
| Fixed amount that is due for specific services | Co payment |
| A patient annual out of pocket limit is 3000, Excluding deductible. As of today the patient has satisfied the 500.00 deductible and has paid 2,300 in coinsurance. How much is the patients balance of coinsurance is owed | 700 |
| What type of plan allows subscriber to pay lower premiums in return for higher deductible called | Consumer Directed Health Plan |
| Prospective Set rates for Inpatient and outpatient services is a characteristic of what type of methodology | Managed Care Contracting |
| Which provision protects the patient from medical expenses that exceed pre set levels | Stop Loss |
| A document required by the primary care doctor to send to the HMO patient to authorize a visit to a specialist | Referral |
| What does EMTALA mean | Emergency Medical Treatment and Labor Act |
| A provider may ask about a patient insurance even if it delayed medical screening and stabilizing treatment-True or False | False |
| Activating the record, obtaining signatures and finalizing financial issues can be completed on what type of patient | Scheduled Pre Registered patient |
| Collecting patient liability after services are performed decreases the need for staff to resolve patient balances and will decrease bad debt True or False | False |
| Medicare provides beneficiary’s with information concerning what? | Right to appeal a discharge decision if patient disagrees with plan |
| Non emergency patients who come for service without prior notification are called what type of patient | Unscheduled |
| What type of patient is used to evaluate the need for an inpatient admission | Observation |
| Which services are Hospice Programs required to provider round the clock basis | Physician, Nursing and Pharmacy |
| What is the initial step in outpatient testing scheduling process | Identify or add correct patient into provider database |
| Having Case management services complete the discharge plan is a step in which process | Discharge |
| If the patients transfer from the ICU to the Medical/Surgical Floor is not reflected in registration can result in what? | Incorrect Nightly Room Charges |
| Helping a patient understand insurance coverage, including what the patient will owe for the current services is the goal of? | Financial Counseling Services |
| APC stands for | Ambulatory Payment Classification |
| Hospital has an APC based contract for payment of outpatient services. Total Anticpated charges for the visit is 2380. The approved APC rate is 780. Where do you apply the patients benefit package to | Apc rate |
| Patient met the 200 individual deductible and 900 or the 1000 coinsurance. The Coinsurance rate is 20%. The estimated insurance plan responsibility is 1975. What amount of coinsurance is due from the patient | 100 |
| Pick one of the following: What is considered valid proof of income documents? Copies of tax returns, Copies of paycheck stubs, Handwritten estimates of net income, List of monthly expenses | Copies of paychecks stubs |
| What the patients outstanding medical bills exceed a defined dollar amount or percentage of assets the patient is considered to be | Medically Indigent |
| Pick one- Which patient assets is considered in the Financial Assistance Application. Stocks, Sources of readily available funds like vehicles etc, Primary Residence, Future earning potential | Primary Residence |
| To ensure that all payments are properly accounted for and deposited is the purpose of what? | Numbered Receipts |
| What is an effective tool to help staff collect payments at time of service | Developing Scripts |
| What must happen at the end of each shift with cash, checks, and Credit card transactions | They must be balanced |
| High Quality standards for registration are important because quality failures can effect what | Joint commission Results |
| Who uses correct insurance information to obtain approval for inpatient days and Coordinate services | Utilization Review Staff |
| Scheduling, Pre Registration, Insurance Verification, and Managed care proces are core financial activities to resolve what access | Patient |
| Patient who is admitted from physicians office on a urgent basis is what type of admit | Unscheduled Direct |
| When is it not appropriate to use observation status | As a substitute for an inpatient admission |
| What type of program provider patients with periodic skilled nursing or therapy services | Home Health Agency |
| What type of information is collected during scheduling contact? |
Created by:
Cvann