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CRCR

Certified Revenue Cycle Registration

QuestionAnswer
The patient centric revenue cycle consists of what three steps? Pre-service. Time of service. Post service.
What does pre-service consist of? The patient is scheduled and registered. Patient service costs are calculated.
What does time of service consist of? Case management and discharge planning services are provided.
What does post service consist of? Bill is sent electronically to health plan. Patient’s account is monitored for payment.
What’s the name given to the 3 HFMA revenue cycle initiatives? Healthcare dollars and sense
What are the 3 HFMA revenue cycle initiatives? Patient financial communications best practices. Best practices for price transparency. Medical account resolution.
This legislated the development of a Health Insurance Marketplace also known as Health Insurance Exchange, where individuals and small businesses can compare and purchase qualified health benefit plans? The Affordable Care Act
Taking the charge for service based on the CPT/HCPCS or MS-DRG code and applying a hospitals health plan contract terms and the patient’s benefit plan to the charges to determine an accurate patient liability is called what? Pricing Transparency
What are the medical account resolution best practices? (8) Bills. Consistency. Coordinate. Educate. Judgement. Report and Track. Timing.
A way of coordinating and linking healthcare resources to avoid duplication, that’s facilitating a seamless movement among care settings is called what? Continuum of Care
SNF Skilled Nursing Facility
DME Durable Medical Equipment
What does remittance mean? A sum of money sent.
HCAHPS Hospital Consumer Assessment of Healthcare Providers and Systems (Patient Satisfaction Metric within the Industry)
There are 27 questions on the HCAHPS patient questionnaire. What is the most important one? Would you recommend this hospital to your friends and family?
Leader ship and staff must always remember what three points in patient satisfaction? Implement. Educate. Communicate.
What percent of billing information is obtained during the registration process? 40%
Revenue cycle activities for improving communication and customer service include what? Modify billing statements. Extend normal business hours. Make sure all staff answer the phone courteously. Resolve questions or complaints. Follow up on all customer inquiries or complaints w/ in 48 hours.
When it comes to compliance the burden of proof is generally on the healthcare facility; therefore, it is imperative to what? Have a plan. Follow the plan.
OIG Office of Inspector General
Defined as “systematic” procedures instituted by a organization to ensure that the provisions of the regulations imposed by a government agency are being met is called: Corporate Compliance Program
CCO Chief Compliance Officer
What does the chief compliance officer role oversee? Code of Conduct
What does the code of conduct represent? The organizations compliance program as well as the organizations culture.
How many corporate compliance program elements are there? 16
What are the areas of focus of the code of conduct? Human resources. Confidentiality. Quality of care. Billing and coding. Conflicts of interest. Laws and regulations.
What is the purpose of a compliance program? To mitigate potential fraud and abuse in the industry specific key risk areas.
HIPAA Health Insurance Portability and Accountability Act
HHS Health and Human Services
Why was the office of Inspector General (OIG) created? To protect the integrity of the Health and Human Services (HHS) Department programs and operations and the well-being of beneficiaries by detecting and preventing fraud, waste, and abuse.
What are The Office of Inspector General (OIG) responsibilities? Identifying opportunities to improve program economy, efficiency and effectiveness. Holding accountable those who do not meet program requirements or who violate federal laws.
Created by: hea24141
 

 



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