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PRE-ENCOUNTER

Quiz yourself by thinking what should be in each of the black spaces below before clicking on it to display the answer.
        Help!  

Question
Answer
show Attitude and Behavior  
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_____________ may be any patient, family member, visitor, physician, other hospital personnel, third party payer, vendors, suppliers, etc.   show
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show Departments, employees  
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EXTERNAL CUSTOMERS are those ____________ the organization who work with us in caring for the patient.   show
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Demonstrating _______________ is equally as important as assuring a clean and accurate claim is generated.   show
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show Problem, correct, outcome  
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Every effort should be made to resolve the problem at the _______ level. If unable to do so, submit the issue in _________ to the manager who will follow up with the patient.   show
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show Partners  
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__________ patients on their rights and responsibilities enhances this partnership.   show
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The PAS should recognize that each patient is an individual with unique healthcare needs, and be committed to assist them in exercising their own healthcare __________.   show
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State and federal laws require us to provide the rights and responsibilities to patients upon admission in a ___________ they can understand, in no smaller than ____ point font.   show
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show Posted  
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show Competence  
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______________ is the process in which messages are transmitted. Effective communication isn't only talking; is also includes ENSURING YOUR MESSAGE HAS BEEN ___________.   show
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show 55, 38, 7  
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Messages are ________ through words, gestures, tone of voice, etc.   show
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Messages are _____________ face to face, over the phone, letter, email, text, etc.   show
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show Decoded  
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show Feedback  
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Fancy medical words that the patient may not know are referred to as ________ ________. Avoid using this at all costs.   show
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show Paralanguage  
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show Nonverbal  
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show Hear them out, Empathize with the customer, Apologize, Take responsibility.  
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Ask _______ ended questions that begin with who, what, when, where, why.   show
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show Diffuse  
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show Belittle  
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Three things registration staff should be able to do is: a. Ask the right questions to complete ________ and verify _________. b. Answer patient's questionsrelating to registration and __________. c. Complete registration with a high level of _________   show
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Scheduling is necessary to maximize patient _____ and _________ wait time   show
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show Documented  
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Name 5 date elements that may be required in the registration system:   show
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Patient medical record number is assigned on their ______ visit   show
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Medical records must be maintained for a minimum of ___ years.   show
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Patients can request copies of medical records ________.   show
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show Payment, Out of Pocket, Funding  
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show Prior  
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show Surprises  
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show Emergency Department  
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According to it, patients must be medically screened and stable before asking for _________,   show
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Doing so prevents discrimination of treatment based on ___________ status.   show
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show Insurance  
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show Payment or Coverage.  
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You CANNOT accept payment before treatment even if the patient __________.   show
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show Written  
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The goal of a PATIENT CENTERED ENVIRONMENT is creating an experience the patient will___________.   show
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show Perception, Unique  
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show HIPAA  
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It also encourages ___________ transactions.   show
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show Age  
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show School Children  
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show Adolescents  
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The nonverbal cues of their _____ language often signal how they feel.   show
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_______ are at the peak of mental, verbal, reasoning, and information recall abilities. They have many responsibilities (Children, aging parents, act.)   show
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show Seniors  
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Waits and delays in service, proper room and food temperature, noise levels, and pleasant smiles are known as ____________ concerns that customer satisfaction.   show
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_______ on behalf of the hospital staff also has a major impact on a patient's impression of the hospital according to a Press-Ganey Study.   show
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According to the study, patients may put up with __________ amenities, but they have a low tolerance for ___________ or _____________ care.   show
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Registration staff should be experienced in working with __________ agencies and _____________ companies and be able to assist patients in determining how accounts should be paid.   show
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show Coverage, Benefits, Cost  
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show wait time  
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show Screened, Stabalized, Economic  
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CMS guidelines mandate that policies for __________ patients be consistent with the policies for all the other patients.   show
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show Correct  
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Posting all payments received on daily ____ ____: giving patients a ______ after paying, and making relevant ________ regarding the patients account in the appropriate place.   show
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Promoting consideration of patient values and preferences includes informing the patient that they can _____________ treatment.   show
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show Joint Commission  
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show Police  
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show Fee, National Standards  
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Accreditation by this agency enhances _____________ confidence, encourages ________ improvement efforts, provides staff ___________ tools, could help meet _______ _______ requirements, expedites _______ ________ payments, etc.   show
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____________ refers to a hospitals ability/willingness to "follow the law" set by the Regulatory Agencies (police).   show
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show Patient, Fraud, Waste  
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show Compliance  
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Communicate standards through _________ programs, perform _______ audits to prevent noncompliance within the hospital, develop lines of communication for reporting ______, and enforce standards through well ______ guidelines and procedures.   show
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_________ is the health insurance portability act of 1996.   show
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Portability means once a person has insurance coverage, when they change health plans (most commonly when changing jobs) the previous coverage may be used to reduce or eliminate ____________ condition exclusions.   show
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The act also attempted to reduce the cost and administration burden of providing healthcare by promoting standardized electronic _______ and _________ transactions.   show
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It also ensures that protected health information (PHI) is _________ and that no personally __________ health information is disclosed.   show
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show Train, Sign, 3  
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___ refers to all things information technology or computer related.   show
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This department helps provide a ________ identity to patient records, provides easier access to _________ and _______________ data.   show
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show Data  
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show Hardware  
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_________ refers to system programs that make the computer run (Windows, Microsoft Word, Excel, Active Dashboard, SMS Invision, AccuRet, etc.)   show
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show Batch Processing  
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__________ is a software application that takes data from one system and sends to another.   show
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show Transmitted  
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show Master Patient Index  
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show Clinical Data Repository  
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show Benefit  
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show Subscriber  
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The policy holder will not _______ be the person whose name appears on the card.   show
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For most Blue Cross, Commercial, and PPO insurance, the policy holder is the person whose name is on the _______.   show
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show HMOs  
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show HMOs  
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The policy holder will be the sponsor or the person who is active or retired military with __________.   show
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show Medicare and Medicaid  
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show Workmans Compensation  
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show Centers For Medicare and Medicaid Services  
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show Government, Quality  
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show Children  
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show Peer Review Organization  
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CMS leads the healthcare industry in the use of __________ ___________ for all phases of claims processing.   show
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CMS combats fraud and abuse to protect ________ dollars and to help guarantee security for ________, ________, and _____ ______ ________.   show
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The department of _______ and the office of _________ _______ work with local and state agencies to protect CMS funds.   show
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show HIPAA  
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show Fiscal Intermediary  
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show Carrier  
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In order for private agencies to handle Government money they are charged to protect taxpayer money by determining _______ _________, detecting and deterring _____, and conducting ______ to ensure the proper amount was paid for service.   show
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show 65, ESRD, 65  
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show Effective  
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Medicare claim numbers are usually the patient or spouse's ___ with a ______/______ prefix.   show
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Common Codes: a. Primary Wage Earner ___. b. Retired Railroad Employee ___. c. Entitled through spouse ___. d. Child ___. e. Widow ___. f. Widower___. g. Disabled Widow ___. h. Disabled ____.   show
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Medicare beneficiaries are automatically eligible on their ____ birthday but must apply __ months beforehand.   show
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show Inpatient Part A, Outpatient Part B  
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Beneficiaries can pay private insurance companies to offer HMO and PPO coverage instead of traditional Medicare coverage through Part ___.   show
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This is also known as ________ _________.   show
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Part ___ helps cover prescription drug plans.   show
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show Hospital, Skilled Nursing Facilities, Hospice  
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show 90  
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The ___ day or ___ hour rule allows all pre-admission or diagnostic services provided within this time prior to admission to be included with the inpatient payment. Doesn't cover _________ services.   show
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show 60  
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The BENEFIT PERIOD begins on the ____ day of services and ends ____ days following discharge if those days aren't interrupted by skilled care in another facility.   show
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Medicare beneficiaries can have an _________ number of BENEFIT PERIODS but they must pay the inpatient ___________ for each period.   show
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show 60, 90, Once  
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IMPORTANT MESSAGE FROM MEDICARE (IMM) is given to all inpatient ________ recipients and explains their rights to care and follow up care after discharge. It also gives them a number to call if they are being discharged too _____.   show
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Hospitals cannot force beneficiaries to leave while their case is being ________.   show
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show Necessary, 20 days, 21-100.  
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HOME HEALTH CARE - Medicare covers full ________ cost of covered HHC services. Patients pay only 20% co-insurance on equipment such as wheelchairs/walkers.   show
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show Doctor, Outpatient, 80%  
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Beneficiaries are responsible for paying ____ deductible per calendar year and the remaining ____ % approved charges.   show
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show Private  
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MEDICARE (PART D) INSURANCE - helps cover __________ drugs and may lower prescription costs.   show
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Be sure to mention to all Medicare recipients that their yearly MEDICARE ENROLLMENT REVIEW is ________ through ________. They can make changes during this time.   show
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show Canada and Mexico  
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show Telephones, Televisions, Medically necessary, Rehabilitation, Custodial  
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show Prescription Drugs, Illness or Injury  
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show Medically Necessary  
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show Signed, Cannot  
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Many Fiscal Intermediaries are using _________ that compares the diagnosis code with a list of medically necessary services. Therefore it is extremely important that the correct code is assigned to the diagnosis.   show
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show Primary, Secondary  
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show Questionnaire, Medicare, Change, Fines  
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show 20, Spouse  
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show Disabled, 100  
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show ESRD  
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Medicare is the SECONDARY PAYER if: d. Patient has Medicare, but is suffering from an illness or injury covered under _______ compensation, the federal ______ lung programs, no fault insurance, or any _____ insurance.   show
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If patient retired before their Medicare entitlement date, but can't remember their exact retirement date, then their entitlement date can also serve as their ________ date.   show
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show 5, 5  
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CMS regulations state that for recurring visits, where one account is reated and the patient has several visits related to the same service (such as physical therapy), all hages for each visit are entered into ____ account.   show
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But, you must verify the patient's MSP information every ___ days.   show
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Medicare avoids excessive INPATIENT stays by paying only a fixed amount according to the patient's diagnosis. It will pay the _______ _______ ______ rate regardless of actual hospital charges or lenght of stay .   show
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show Low, teaching, Add-On  
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This DRG payment is important to keep in mind when a patient questions the total amount of their inpatient bill because Medicare's reimbursement is rarely influence by the _____ _______.   show
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show Ambulatory Payment Classification  
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show 20%, Co  
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For lab and physical therapy, Medicare pays according to a ___ schedule.   show
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Unintentional failure to follow CMS guidelines carries severe _____ and _______. In cases of intentional fraud, Medicare will not only pursue the hospital, but the _______ as well.   show
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show Employee, Retiree, Medigap  
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show Cost, Insurance, Deductibles  
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MEDICARE SELECT is a type of supplemental insurance that generally has lower premiums than other policies because each insurer has specific _______ and often specific ________ that participants must use.   show
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show Emergency, HMO  
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MEDICARE BENEFICIARY NOTICES (MBN) - an easy to read monthly __________ that clearly lists claims information.   show
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MEDICARE + CHOICE-plan that manages the Medicare coverage for its members and may provide benefits like coordination of care or reduce out of _____ expenses.   show
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Members may also get prescription drug benefits or additional days in the hospital. Medicare pays a set amount of _____ for your care every month to these private health plans. Patient must have Part __ and __ to be eligible.   show
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MEDICARE MANAGED CARE PLAN PROCESS - in most cases, patients can only go to certain ______ that agree to treat members of the plan a. Doctors can join or leave Managed Care Plans __________.   show
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b. Patients usually need a _______ from a Primary care Physician to see a specialist and risk higher co-pays without one.   show
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c. Patients pay _____ if they go outside the network, unless it's an emergency or urgent care.   show
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d. Dome Managed Care Plans offer a POint of Service option which allows patients the option to go to doctors _______ the network, but pay more.   show
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PRIVATE FEE FOR SERVICE - in this case the private company rather than __________ determines how much it pays and how much the patient pays for services.   show
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show Provider  
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b. Private company pays a ____ for each service, and patient my also have a __ ____.   show
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c. Patients could pay _____ if the plan lets provider bill more than the plan pays for service.   show
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In order to receive Medicare through other health plan choices, the beneficiary must have Part __ and Part __, continue to pay the monthly part B _____ , live in the plan's service ______, and not have _______.   show
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Medicare beneficiaries in managed care plans should have a Medicare card as well as a _____________ card. They still receive Medicare _______ services and retain all Medicare _______ and protections.   show
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show Auto Insurance  
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show Eligibility, Services  
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MEDICAID QUALIFICATIONS are certain low income families with ______, aged, blind, or disabled people on Supplemental Security Income, certain low income ______ women and children, and certain people who qualify due to _________ medical expenses.   show
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show Inpatient, Children  
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show Regular, Head, Individual  
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HMO MEDICAID contracts are determined by the State and contracts are usually arranged so that claims are submitted to and paid by the ___, which is reimbursed by Medicaid.   show
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show Secondary  
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WORKER'S COMPENSATION - services related to the result of ____ related accidents or injuries and are paid by the employer or the employer's workers compensation insurance company.   show
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show Employer, Authorization, Person  
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b. Key information to obtain in Worker's Comp. cases: _____ and date of injury, type of _____, name of ______ and ______ person, their ________ supervisor, Employee insurance information (in case injury is determined ____ to be work related).   show
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show All, Primary, Primary  
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show Number, Billing, Adjusters  
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show Negligence, Card  
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show NOT, Commercial, Primary Care Physician, Hospital  
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PREFERRED PROVIDER ORGANIZATIONS (PPOS) - PPOS are contracts between employers, _______, and _________. a. Doctors and hospitals provide services at a __________ in return for receiving large volume of _______ who are PPO Members.   show
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show Providers  
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c. Members do not have to select a PCP but must use a participating provider to obtain _____ coverage.   show
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show Decrease, Pocket  
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show Card, List  
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show Control, Facilities  
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show Lie Threatening, Approved, PCP  
🗑
show HMO  
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show 01, 02, 03  
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e. Many HMO cards display the ____'s name and phone number as well as co-pay information. Some HMOs specify that non-participating claims be sent to a different _____ than participating claims.   show
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TRICARE - healthcare program overseen by the ______ of ______ in cooperation with regional civilian contractors.   show
🗑
show Prime, Extra  
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show Standard, For Live  
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show Veterans  
🗑
show Prime  
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show Military  
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show Primary, Secondary, Primary  
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show Medicare, Family, Spouses  
🗑
Patients must have Medicare Part ___ to be eligible for TFL.   show
🗑
show Visiting the website  
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Accurat coverage information regarding specific services and if preauthorization/certification is needed should be handled ___________ . Why?   show
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The COMMON WORKING FILE (CWF) is a tool used to verify Medicare __________.   show
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It verifies: A. If a patient has ___ and ___, their effective dates, whether they have switched from Medicare to Medicare Advantage (________). B. If the patient or spouse is _______ and if they are covered by _____ ______.   show
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C. If the patient was involved in an _______ where the car is still open. D. The number of full and partial days remaining in the _______ _____. E. The number of ____ ____ ____ days remaining, and if the patient is on _______ care.   show
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Medicaid can be verified through your _____ website or their CWF Verification System.   show
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A. Subscriber _____ s important concerning admission out of network. B. The ____ phone number is also important in case a referral is required.   show
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__________ ___________ refers to the person being entitled to benefits and covered. The date they became eligible for the plan is important to know since info can change from month to month.   show
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show Authorization Requirement  
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Certain insurance companies require ___-_____________/_____________ from the PCP prior to services being performed.   show
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The TOTAL amount of money policyholder will pay for medical services for himself and all dependents in a GIVEN TIME PERIOD is known as ____ of ______ _______. Once this limit is reached, benefits increase to ___%. _____may or may not contribute to this.   show
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The amount of eligible expenses a covered person must pay each year out of pocket before the plan pays for eligible benefits is known as ____-_____________.   show
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show Co-Insurance  
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____ ____refers to purchasing a service o medical device separately which is typically a part of an HMO plan.For example, an HMO may ___ ____behavioral health benefits,select a specific vendor to supply these services,and offs them on a stand alone basis.   show
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show Lifetime Maximum  
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Procedures hat are not included and covered on a plan are known as _____________.   show
🗑
show Verify The Physician, On-Call  
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______________ of _____________ - refers to the way of determining the order in which benefits are paid and the amounts that are payable when a patient is covered by more than _____ health care plan. The intention is to avoid ________ of payments.   show
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BIRTHDAY RULE - when a child is covered under both parent's insurance, then the parent whose birthday (using month and day) occurs _______ in the year is primary.   show
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A. Ex.,if Steven's son is covered by his and his wife Kathy's insurance, and her birthday is in June and his is in November, then ________ insurance will be primary.   show
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B. If both of their birthdays are in April and Steve's is on the 11th and Kathy's on the 21st, then ______ will be primary.   show
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When parents are not together and a court decree exists, then: A. the plan of the parent with ________ is primary. B. the plan of the _________ (spouse with custody) is primary.   show
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show Custody, Non Custodial  
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show First  
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show Secondary, Maximum  
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show No  
🗑
show Authorization  
🗑
show Before patient arrives to the hospital  
🗑
show The time while the patient is at the hospital  
🗑
show Gather, Patient, Reimbursement, Rights  
🗑
E. obtain consents from ______ and authorizations from _________ F. collect co-pays and ________ G. direct the patient to the _____ of _______ H. make the patient feel comfortable and __________   show
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show Advance beneficiary notice  
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First impressions are imprinted in the patients mind during the _________ because they can observe the staff's __________ and attitudes.   show
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show Patient Identification  
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Proper patient identification includes obtaining the patient's ________ name, ______, and additional identifying information.   show
🗑
show Master Patient Index  
🗑
show Master Patient Index  
🗑
show Identification, Safety  
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all healthcare workers must use a minimum of ____ identifiers (name, date of birth, etc.) when providing care treatment, and services.   show
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In addition to accurately identifying the patient, patient access staff should follow the facility directed guidelines to secure the patient's __________ and _________ information.   show
🗑
show Identity theft and insurance fraud  
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show Physician's Order  
🗑
show Language Barriers  
🗑
show Visitors, Hard of Hearing  
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show Fall, Liable  
🗑
Hospitals must also provide waiting room chairs, special beds, and large wheelchairs to preserve the dignity and safety of ______ patients.   show
🗑
Also known as "bed control" or "bed placement", hospitals must provide the most _________ location and level of service necessary for ______ clinical care. CHAA refers to this as _____ ________ .   show
🗑
An important factor to consider in patient placement is _____ _____. A. In acute care hospitals, infected patients should be placed in a _____ rooms when available. B.When not available, patients with the same MRSA should be placed in the ______ room.   show
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show Weakened  
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The Center for Disease Control And Prevention (CDC) identified these standard precautions as crucial to preventing the spread of disease: A. _____ _______ B. _______ ________ Equipment C. ________/_________ etiquette   show
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If hands are not soiled, the preferred methos of documentation is an ______ based hand rub. If hands are visibly soiled, use only after removing visible materials with ____ and ______.   show
🗑
show Effectively and Quickly, Damaging, Time, Accessible  
🗑
show Active Care  
🗑
show Bed, monitoring, evaluate, 24-48  
🗑
show Outpatient Care  
🗑
show Ancillary Services  
🗑
show Unscheduled emergent, Immediate  
🗑
A. Depending on diagnosis, patient could be admitted as an __________ _________, or transferred to another facility.   show
🗑
____________ ____________/Same Day Surgery is where patient receives surgical treatment and is discharged within ___ to ____ hours of procedure..   show
🗑
____________ SERVICES are known as physical/occupational therapy, cardiac or pulmonary rehab that occurs over time based on doctor's order.   show
🗑
LONG TERM CARE is generally provided to the ______________ ill, _________ or those in a nursing home. A. Services include 24 hour ______ care.   show
🗑
B. Occupational/Physical/Speech _______ as well as assistance with daily living. C. Medicare beneficiaries are eligible for ____ days and Medical is available for those who have ____ their own resources.   show
🗑
show Respita Care, Time Off, Reimbursed  
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________ is a non-profit organization dedicated to families and patients facing ________ illness or _____. A. It alows patients to share their last days together in their own ____ or hospice designated facility. B. It is _______ under Medicare.   show
🗑
show Clinical and Financial, Accurate  
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Demographic information is verified by obtaining positive _____________ of the patient in combination with a A. ______ _____ conducted using B. ____ _____ questions.   show
🗑
In patient access, the patient or _____ ____ is required to sign the consent form   show
🗑
A. _______ prior to obtaining signature and the patient should be given B. ___ to ____ the document and ask ______ C. Most facilities include on this form a release of information for _________ purposes.   show
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show Sign and date, Relationship, Witness  
🗑
show Document, sign  
🗑
show Supervisory or Clinical  
🗑
show  
🗑


   

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