CRCR study
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ERA | show 🗑
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Level 1 of ERA | show 🗑
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show | Electronic remittance is received, entered into computer, and viewed at terminal
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Level 3 of ERA | show 🗑
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show | Total automation receipt, data entry, payment posting, adjustment processing
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EFT | show 🗑
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SNF Services Covered (6) | show 🗑
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show | Electronic Data interchange
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EDI used for? | show 🗑
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835 | show 🗑
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Violation of the DRG Window (3 day) causes | show 🗑
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UBO4 is used for institutional providers(List 4) | show 🗑
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show | must be IP atleast 3 days before discharging to SNF, must be admitted with in30 days of IP stay.
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show | Inpatient billing
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show | outpatient billing
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Benefit SNF Period? | show 🗑
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show | Program consists of Edits implemented w/claim processing to catch errors before sending out
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Package Pricing is? | show 🗑
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Site of service limitation? | show 🗑
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Title 804 | show 🗑
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Title 805 | show 🗑
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Title 806 | show 🗑
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show | deceptive or false representations
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Title 604 (FCRA) | show 🗑
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show | 2 90 day periods and unlimited subsequent periods-60 days each
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show | physicians, allied health professions, CRNA, home health agency's and Medical Equipment suppliers
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What is EFT balancing and Control | show 🗑
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Common Provision found in manage care contracts for protection for medical expense that exceed certain levels. | show 🗑
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Per Diem payment | show 🗑
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Percentage Discount is | show 🗑
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show | Percentage discount, DRG, APC, Case Rate, Per Diem, Package Pricing, Capitation
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show | Capitation
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show | Contractual allowance
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The first critical step for all patients arriving for service scheduled or unscheduled is verifying patients identity with 2 forms...list | show 🗑
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show | new technology used without determining coverage(3D), charges bundled/unbundled incorrectly, accuity level changes but pt type does not change, admission notification not done, Pt IP but should be OBs, test performed not ordered, invalid HPCPS coding
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Post Service Denials include | show 🗑
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show | No Pre Auth, clinicals not called for certification, INS not verified, Inaccurate Data entry, Copying registration without verifying
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CLIA | show 🗑
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APC only covered under medicare part | show 🗑
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show | Productivity(staff reworks files), patient loss of confidence, employee frustration increased(morals affected)
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show | Cash, Credit, check or debit cards
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show | Auto, Work Comp, Premises for medical coverage under property cases
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show | SUBORGATION
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show | 120 days.
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show | Lien
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CWF | show 🗑
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show | Beneficiary appeal and Provdier appeal
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Second Placement accounts are | show 🗑
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show | Fair Credit Reporting Act
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show | Title I- established rules for consumers credit and sales and loans
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show | 120 days then goes to collections agency
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For an acount to be considered bad debt collection must have been attempted and documented T/F | show 🗑
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show | 13 days electronic/26 for paper claims
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show | Medical Record
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MPI | show 🗑
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CPI | show 🗑
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show | Legal name, DOB, sex, SSN
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show | Wheelchairs, hospital beds, oxygen tanks
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show | Home Health Care
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Patients with incurable disease and have a life expectency of six months or less | show 🗑
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Orthopedic surgical patient that require intense PT/stroke PT who require comprehensive Rehab | show 🗑
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Can you use a ABN for a IP stay | show 🗑
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When is a ABN required | show 🗑
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Credit balances are created by | show 🗑
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Chargemaster issues can result in | show 🗑
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Claim rejection is a claim rejected for a # of reasons (list some) | show 🗑
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Medicare Claims must be filed within what qualifying time limit? | show 🗑
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show | Emergency, urgent inpatients, routine walkins outpatients, ED outpatients, obs patients, Newborn
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3 types of schedule patients | show 🗑
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Enrollment and disenrollment of a healthplan transanction set | show 🗑
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What must appear on the ABN? (5 items) | show 🗑
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show | provider received a flat fee every month for taking care of individual
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show | specific condition forms the basis for establishing a single payment for all services(colonscopy)
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show | Full payment proir to service, short term payment plan, bank loan
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show | payer does not pay the agreed contract(Aetna) amount to provider(LUH)
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show | Demographic error, imcomplete insurance 411, no precert or auth, no contunied stay auth, exceeds frequency limit(pt visits)
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show | not medically necessary, diagnosis and cpt do not match, carve out days, inappropriate level of care, HCPCS incorrect for procedure
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show | Straight- involuntary or voluntary
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Chapter 11 | show 🗑
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show | Rehabilitation- does not liquidate-looks for future earnings
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show | In network
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show | 100 (often use of swing beds)
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show | 03
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837 transaction set | show 🗑
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show | claim payment/remittance advice
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277/278 transaction set | show 🗑
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820 transaction set | show 🗑
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Created by:
Copa
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