AAHAM CRCS Certification Chapter 3 - Patient Access / Front Office
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| show | Advance Beneficiary Notice of Noncoverage
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| What does HINN stand for? | show 🗑
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| What are the primary functions and responsibilities of Patient Access / Front Office? | show 🗑
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| show | Admitting, Patient In-take, or Registration
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| (P) What is the primary duty of the front office personnel? | show 🗑
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| What does the front need to focus on to have continuous improvement in the patient access process? | show 🗑
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| What is the first way to maximize facility/ office productivity? | show 🗑
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| How can efficient and effective scheduling help the entire office or hospital? | show 🗑
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| show | Errors in scheduling can create havoc, downtime, overbooking, and dissatisfied patients.
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| What are the three elements that scheduling need to balance? | show 🗑
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| What is gathered during the preadmission and preregistration process? | show 🗑
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| Why should complaints decrease with the implementation of a preregistration program? | show 🗑
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| What other things can be done during preregistration? | show 🗑
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| What does Precertification mean? | show 🗑
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| show | It is to treat and authorize for an average length of stay/number of services allowed for the pt's condition are obtained.
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| show | Billing can be delayed while retroactive authorizations/copies of medical rec are obtained. Sometimes, completely denying the claim which increases appeals, time spent by billing staff to rework and lost revenue.
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| show | If emergent/non-emergent, new or estb pt, reason for appt, preferred provider, Pt demos, referring provider, PCP, insurance info, third party involvement. Guarantor demos.
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| show | The person who is responsible for the bill.
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| show | A patient who has not received any professional service from that physician or any physician in a group practice within the past three years.
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| show | Pulling charts, preparing fee tickets, obtaining referrals for visits, obtaining preauth to see if a patient's insurance will cover a specific procedure.
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| What is a referral? | show 🗑
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| What responsibilities do the registrar have? | show 🗑
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| show | Greeting and checking the pt in, obtaining info for the pt info form, distribute required materials, check the patient out, maintain pt chart, verify ins eligibility, adhere to privacy requirements,
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| show | Verifying patient info again, make copies of current insurance card, collect patient copays.
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| show | HIPAA privacy notice, Patient Care Partnership brochure / Bill of Rights. (Not on test, but financial policy)
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| show | Scheduling next appt, collecting financial obligations, completing requisitions for ordered tests, schedule an tests, obtain patient signatures as needed.
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| What is involved in maintaining the patient chart? | show 🗑
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| show | Precert required/obtained, dx covered, 2nd opinion needed? Ded, Coin, OOP Max, Claim submission address/phone, TPA? Auto/WC? Approved # days, Daily room and board allowed? Who is subscriber, Employer?Any limits
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| What tasks does financial counseling include? | show 🗑
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| show | Explain hospital collection policy. Calculate the pt's estimated responsibility based on (ALOS for dx, cost per day, length of stay, procedure being performed, DRG, room charge, TPA)
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| show | diagnosis-related group
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| show | average length of stay
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| show | Point of service
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| What is the only cost-effective way to collect small-dollar copayments? | show 🗑
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| show | Yes
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| What are the 5 facility collection control points? | show 🗑
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| What are the 5 provider practice collection control points? | show 🗑
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| show | True - Once the urgency is gone, patients are less inclined to pay their portion of the bill.
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| What is a deposit? | show 🗑
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| How can deposit be collected. | show 🗑
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| What are the advantages of a deposit collection program, when combined with a good preregistration and insurance verification program. | show 🗑
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| What are disadvantages of a deposit collection program? | show 🗑
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| What does a compliance plando? | show 🗑
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| show | Yes
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| Why does patient access play a key role in complaint billing? | show 🗑
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| show | Important Message from Medicare, MOON, Guarantor forms, ABN, HINN,
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| show | Medicare Outpatient Observation Notice
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| show | Advance Beneficiary Notice of Noncoverage
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| show | Hospital Issued Notice of Noncoverage
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| show | It is a message from Medicare that hospitals are required to give all Medicare and Medicare Advantage beneficiaries who are hospital inpatients. Muse be issued within two days of admission and again within two days of discharge.
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| show | It is a standardized notice to inform beneficiaries when they are an outpatient receiving observation services and are not an inpatient of the hospital or critical access hospital.
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| What does NOTICE stand for? | show 🗑
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| When is the MOON required to be given? | show 🗑
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| What beneficiaries does the MOON apply to? | show 🗑
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| show | Applies to Medicare Part A and Medicare Advantage plans, as well as patients in Psychiatric and Critical Access Hospitals.
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| show | Signed by the staff member. Must include the staff member name and title, that they presented the MOON, date and time. They must annotate the Additional Info section of the MOON.
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| What is the purpose of an ABN? | show 🗑
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| What is an ABN? | show 🗑
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| When does an ABN need to be obtain to be valid? | show 🗑
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| show | Provider, Pt name and DOS, What the service is, Why provider things it is not covered, price of noncovered item, what the patient wants to do (their options), pt signature and date.
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| show | No.
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| Should every patient get an ABN? | show 🗑
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