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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
Customer Service impressions are formed by the staff's ________ (state of mind) and ______________ (action/reaction) towards them.   show
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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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show Outside  
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Demonstrating _______________ is equally as important as assuring a clean and accurate claim is generated.   show
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THREE KEY QUESTIONS TO HANDLE CUSTOMER ISSUES: a. What is the _________ ? b. What has the customer attempted to do to __________ the problem? c. What would the customer like to see as an ___________ ?   show
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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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show Decisions  
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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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show Transmitted  
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Messages are ________ by the person who receives it when they try to figure out what it means.   show
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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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Your role in dealing with angry patients is to _______ the situation by acting with patience, tact, and diplomacy.   show
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show Belittle  
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show registration, Insurance, Billing, Accuracy  
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show Flow, minimize  
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If it is not _______________, it did not happen.   show
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show Patient name, address, phone number, Advance Directive, Employer info.  
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Patient medical record number is assigned on their ______ visit   show
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show 10  
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show Anytime  
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Financial clearance is also known as "financial pre-determination" and is where the provider identifies _________ sources to assist the patient in determining their expected _______________ costs, reimbursement, and alternative _______ sources.   show
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show Prior  
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show Surprises  
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The EMTALA act is especially relevant to patients in the __________.   show
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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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Before screenng/stabilization takes place, patients can be asked if they have ________ and to make a copy of their card.   show
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show Payment or Coverage.  
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show Volunteers  
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Patients must give _________ authorization before discussing payment with a third-party payer.   show
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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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Registration personnel are required to treat patients differently in relation to their ____.   show
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show School Children  
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______________ are able to discuss problems but are often afraid to do so because they may be afraid/embarrassed to ask/share.   show
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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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________ have decreased memory and a slower ability to process information. Address as Mr./Mrs. "Last Name".   show
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show Traditional  
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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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You should acknowledge all walk ins, even if you are with another patient with an approximate ______ ________ of when you will be able to assist them.   show
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According to EMTALA, patients must be _________ and ____________ before asking for payment. Doing so prevents discrimination of treatment based on __________ status.   show
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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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show Cash sheet, receipt, comments  
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Promoting consideration of patient values and preferences includes informing the patient that they can _____________ treatment.   show
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The Regulatory agencies provides accreditation by setting standards concerning health care which providers must follow in order to receive Medicare and Medicaid   show
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show Police  
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Providers seek accreditation from this agency by paying a ____ and agreeing to be measured by ____________ ____________.   show
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show Community, Quality, Education, Medicare Certification, Third Party  
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show Compliance  
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Doing so improves ________ care, reduces _______, ______, and also reduces the cost of healthcare to federal, state, and private health insurers.   show
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show Compliance  
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show Education, Internal, Violations, Publicized  
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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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show administrative and financial  
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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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show IT  
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This department helps provide a ________ identity to patient records, provides easier access to _________ and _______________ data.   show
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It also helps ensure ______ integrity.   show
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_________ refers to keyboard, monitor, central processing unit (CPU), printers, servers, cables, cord, etc.   show
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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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The ___________ ___________ _______ stores the health systems entire population and can uniquely identify each patient based on certain key data.   show
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The __________ ______ ____________ provides ready access patient data from different areas of the healthcare network. Such data can be integrated into a single long term record for the patient.   show
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A __________ is coverage for a certain type of medical condition.   show
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show Subscriber  
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show Always  
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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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Most ________ give each insured person his or her own card. This means the person whose name is on the card may not be the policyholder.   show
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show HMOs  
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show Tricare  
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The policy holder will always be the patient with _________ and __________.   show
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The employer is usually the policy holder for __________ ____________.   show
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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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An organization administered by CMS to improve quality of care for Medicare beneficiaries to review complaints, cse review,s, outreach activities, and disease prevention campaign is a ____ ______ ____________.   show
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show electronic Transactions  
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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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show Medical Necessity, Fraud, Audits  
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Medicare is for people at or over the age of ___, those of any age with ____, and certain disabled people under the age of __.   show
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Medicare cards identify if the patient has Part A and B and will list the date these benefits became _________.   show
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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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show 65th, 3  
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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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show Part D  
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Part A helps pay for inpatient ________ care, ______ ________ __________ home health agencies and _______.   show
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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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show Reviewed  
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show Necessary, 20 days, 21-100.  
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show Approved  
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MEDICARE (PART B) INSURANCE - helps pay for _______ services, _________ hospital services (including ER visits), ambulance transportation, diagnostic tests, lab, some preventative care, etc. It pays ___% of approved charges for most covered services.   show
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Beneficiaries are responsible for paying ____ deductible per calendar year and the remaining ____ % approved charges.   show
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MEDICARE (PART C) INSURANCE - Medicare beneficiaries can elect to assign their benefits to a ______ insurance company that has special coverage for seniors .... usually an HMO/PPO.   show
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show Prescription  
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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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Medicare Part B usually doesn't pay for ________ _____, physical examinations or services not related to treatment of an _____ or ______. It doesn't pay for dental care, cosmetic surgery, foot care, hearing aids, eye exams, or eyeglasses.   show
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The ADVANCED BENEFICIARY NOTICE should be given to Medicare recipients if Medicare may not consider the service _______ _______ and there is a good chance the patient will have to pay.   show
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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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Medicare is the secondary payer when another insurance is _________ and therefore Medicare is the __________.   show
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A MEDICARE SECONDARY PAYER _____________ must be completed on all _________ patients each time service is provided because this information can _______ from visit to visit. Failure to do so can result in ______.   show
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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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show Retirement  
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If a Medicare beneficiary worked beyond their retirement date but cannot remember their exact date of retirement, and it has been at least ___ years since they retired, you can subtract ___ years from date of service as the retirement date.   show
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show One  
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show 90  
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show Diagnostic Related Group  
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The only conditions where Medicare will pay more are f the hospital serves a great percentage of ___ income patients or is an approved _____ hospital. This extra amount is known as an ____ ___.   show
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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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The three tyoes of Medicare SUPPLEMENTAL Insurance coverage includes: ___________ (employer or union), __________ (from a former employer or union) or _________ (from a private company or group).   show
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MEDIGAP is a private insurance designed to help pay Medicare _____ sharing amounts such as co_______, _________, and uncovered services.   show
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show Hospitals, Doctors  
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Except in _______, in order to receive full benefits. It is similar to an ____   show
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show Statement  
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show Pocket  
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show Money, A and B  
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show Providers, anytime  
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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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show More  
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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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show Medicare  
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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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show More  
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show A and part B, Premium, Area, ESRD  
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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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If a patient has Medicare HMO and is in an automobile accident, who should be the primary payer?   show
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show Eligibility, Services  
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show Children, Pregnant, Catastrophic  
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show Inpatient, Children  
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TRADITIONAL MEDICAID eligibility is evaluated on a _______ basis. The Medicaid card is issued to the _____ of each family, which will list the names and ______ ID numbers for each person covered.   show
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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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a. The ________ must authorize worker compensation services. Employer must be contacted for __________. For billing, a claim number and the name of ______ authorizing the service is required.   show
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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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AUTO INSURANCE - usually primary for ___ victims of auto accident's. a. If patient has no health insurance, then auto insurance would be ______. b. If patient has Medicare or Medicaid, then auto insurance is _______.   show
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show Number, Billing, Adjusters  
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LIABILITY - coverage for injuries resulting from ______ of another party. If the patient slipped and fell on a freshly mopped floor in a business and a sign was not posted that the floor was wet, the business would be liable. There is no ins. _____.   show
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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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b. These doctors/hospitals are known as participating ____________.   show
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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  
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c. Not all cards have ____ on them. Most HMOs issue cards to each family member with their name instead of the policyholder's. Many add a suffix to the end of the policy holder to identify the cardholder's relationship to the subscriber.   show
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d. So if I am the policy holder, my suffix would be 00, my wife's would be __, my oldest child would then be __, and my youngest child would be ___.   show
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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
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show Prime, Extra  
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FOUR TRICARE OPTIONS; C. Tricare ______, a fee for service option the same as the former CHAMPUS. D.Tricare _____ provides expanded medical coverage for Medicare eligible beneficiaries.   show
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show Veterans  
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show Prime  
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show Military  
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Tricare has a series of rules to determine the ______payer. Generally Tricare is the ______ payer to coverage from other health plans (HMO/PPO).Tricare is the ____ payer if the other coverage is Medicaid or when a pt. is eligible for Indian Health Service   show
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show Medicare, Family, Spouses  
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Patients must have Medicare Part ___ to be eligible for TFL.   show
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You can usually verify basic information such as date coverage began, active/inactive status, and is the patient the policyholder or a dependent, what are deductibles, and copay information by ________ ____ ___________.   show
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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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show Coverage  
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show A and B, C, Employed, Employer Insurance  
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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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show State  
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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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________ _________ refers to a limit that once reached, prevents any further funds from being available for coverage or any further services. Could be for a calendar year or a lifetime.   show
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Procedures hat are not included and covered on a plan are known as _____________.   show
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Be sure to ______ ______ _______ to insure he/she is on the panel of providers or the patients insurance. This is especially important when a patient comes in unassigned and is treated by the physician ___ _____.   show
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show Coordination of Benefits, One, Duplication  
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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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C. The plan of the parent who does not have ________. D. the plan of the ___ _______ stepparent.   show
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show First  
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A. The _______ plan is billed after the primary plan has made the _________ payment allowed.   show
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show No  
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show Authorization  
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show Before patient arrives to the hospital  
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Encounter refers to __________________________________.   show
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show Gather, Patient, Reimbursement, Rights  
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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
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show Master Patient Index  
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show Master Patient Index  
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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
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Doing so helps prevent _____ _______ and _________ _________.   show
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The _________ _________ is a good source of information to determine if the patient has a special needs.   show
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show Language Barriers  
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Reasonable steps must be taken to communicate effectively with patients, family members, and ________. This also included those who are _______ of ________.   show
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The Joint Commission requires that hospitals provide a ____ reduction program because if a patient falls on an unmarked wet floor, UMHC will be _____ for the medical bills.   show
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Hospitals must also provide waiting room chairs, special beds, and large wheelchairs to preserve the dignity and safety of ______ patients.   show
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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
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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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Staph infections, including MRSA occur most frequently among persons in hospitals and healthcare facilities with _________ immune systems.   show
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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
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Alcohol-based rubs kill germs more _________ and __________. A. are less _______ to the skin B. requires less __________ C. and are more _________ than soap and water.   show
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show Active Care  
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OBSERVATION care is limited to: A. the use of ___ and periodic ________ by hospital staff. B. Services should e reasonable and necessary to _________ the need for a possible hospital admission. C. Care USUALLY doesn't exceed ___-____ hours.   show
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_________ ______ is treatment received at a hospital, clinic, or dispensary but the patient is not hospitalized.   show
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show Ancillary Services  
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In EMERGENCY SERVICES, patients are examined on an _________ _______ basis for ________ treatment in the emergency facilities at a hospital.   show
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show Observation Inpatient  
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show Ambulatory Services, 4 to 6  
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show Recurring  
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show Chronically, Disabled, Nursing  
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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
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________ _______ is short term care provided to people caring for elders/mentally/physically dependent family members. A. It gives the care givers ____ ___ from taking care of their loved ones. B. It is not ________ through Medicare or Medicaid.   show
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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
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show Clinical and Financial, Accurate  
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show Identification, Verbal Interview, Open Ended  
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show Patient Representative  
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show Explained, Time to Review, Questions, Financial  
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The patient representative must _____ and _____ the form and may be required to list their: A. ______ to the patient. B. Patient Access Staff must also sign the form as a ________.   show
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show Document, sign  
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When patient refuses to sign consent form in a scheduled, elective, or walk in clinic, ________ or _______ involvement may be required to address patient concerns.   show
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show  
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