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CBCS: Module 1 Notes
| Term | Definition |
|---|---|
| What are the steps of the revenue cycle (1-8) | (1) Registration and Scheduling (2) Patient Check-In (3) Utilization Management Review (3) Health Care Encounter and Documentation (4) Charge Capture and Coding (5) Patient Check-Out (6) Billing (7) Payer Adjudication (8) R/P Reimbursement, |
| What are the steps of the revenue cycle? (9-11) | (9) Appeals/Correction, (10) Payment Responsibility Collection, (11) payments and posting |
| What allows a collaborative Exchange of Information to flow among a healthcare organizations departments? | Integration of the revenue cycle |
| What does the integration of the revenue cycle mean for the health care organization? | It allows for optimal reimbursement of patient care and services |
| What type of approach makes the reimbursement faster for patient verification, billing, and claims information? | An automated approach |
| How long does the CM/MS require that health insurance claims are retained for? | 6 years but it can be longer in some states |
| What HIPAA rule regulates the reporting of impermissible users or disclosures of PHI? | The HIPAA Breach Notification Rule |
| What are the elements of a record release form? | Identification of the organization and patient, timeframe, information requested to be released, purpose of request, dare of the request, and an original signature from the patient or legal guardian |
| What is the purpose of an ROI? | It allows medical records to be shared with specific people that have the patient's consent |
| When can a provider send the patient's information without patient permission? | For the use of treatment, payment, or operation (TPO) |
| What is the NCCI? | A series of paired codes that represent services rendered on the same day by the same provider; National Correct Coding Initiative |
| What is the purpose of NCCI? | This list serves to identify if the paired codes can be used together, require modifiers to be used together or are inappropriate when used together |
| How can audits be performed? | By comparing the encounter notes and all related documentation to the codes that were billed on the claim |
| What is the purpose of internal audits? | To focus on the prevention of erroneous claim submission that can lead to an external audit |
| What is the purpose of external audits? | To perform reviews to protect the payers and government programs from fraud and abuse |
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