AAHAM CRCS STACK 3 and 4
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What are the primary functions and responsibilities of Patient Access? | show ๐
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What are the collection control points for a Facility? | show ๐
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What are the collection control points for a provider practice? | show ๐
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show | MC OP Observation Notice:
because hospital IP is part A and observation is part B, the Notice Act requires MOON to be given to pt hospitalized more than 24 hours if they are in observation status.
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When is the MOON expected to be given and to whom does it apply? | show ๐
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show | Hospitals are required to give this to all MC and MC Advantage beneficiaries who are hospital inpatients:
w/i 2 days of admission
AND
w/i 2 days of discharge
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What are the functions of Case Management (F)? | show ๐
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show | Hospital issued notice of non-coverage
- like an ABN for hospital inpatients
svcs NOT requiring an ABN/HINN:
-svcs listed in MC Manual
-screenings: mammo, prostate, routine phys, routine foot care, cosmetic surgery, dental, self administered drugs
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show | Per CMS, required to retain ABN 5 years from discharge/completion of care (unless the state requires longer) whether the pt accepted/refused care.
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What are the ABN triggering events? | show ๐
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What is an ABN and what must it list? | show ๐
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show | Prevent, ID and remedy instances of fraud, abuse or other unacceptable conduct.
Issuing important docs:
MOON, Guarantor forms, ABN, HINN, Important Message from MC.
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Explain Inpatient and Observation levels of care: | show ๐
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Explain ER/ED and recurring/series levels of care: | show ๐
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Explain what LTC (level of care) stands for and describe: | show ๐
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Describe office and Outpatient levels of care: | show ๐
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What does SNF (level of care) stand for and describe: | show ๐
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show | Hospice: no life saving measures, keep pt comfortable and without pain.
Respite: to give a break to non-paid care providers
Home Health - Part time in home nursing care
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Consent forms: general vs special | show ๐
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list and describe the Types of Consent: | show ๐
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What does AOB stand for and describe | show ๐
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show | The child has:
-fathered or given birth to a child
-no longer requires parental guidance/financial support
-has reached the age of majority
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show | -Intoxication
-unconsciousness
-declared mentally incompetent by courts
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show | - Must be clear and concise, legible and well organized
- can never alter, erase, delete, remove or destroy a record
-if correction is needed, authorized personel can draw a single line strike-thru and initial. NO white out.
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Who is authorized to make entries in a patient's medical record? | show ๐
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show | - w/ pt written consent
-subpoena from a court and proper notice to the patient or patient's legal rep.
-may be delivered by fax from 1 facility to another w/ auth.
- specific auths are required for dx like hiv, psych, alcohol and drug.
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show | Can be accepted by:
Physician/physician extender (PA, NP, etc) or RN
MUST CONTAIN:
-date and time of order
Name of ordering physician
name of pt and their status
exact order, verbatim
full name and title of staff member documenting
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show | National Coverage Determination: med review policies issued by CMS that ID specific DME, svcs, procedures or tech that MC can cover.
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show | Local Coverage Determination: policies made by MACs that specify criteria for svcs and show under what clinical circumstances an item/svc is considered to be reasonable, necessary and appropriate.
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What is a Definitive Diagnosis? | show ๐
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show | Provides potential cov scenarios, not specific dx, signs, symptoms or ICD-10 codes. usually says something like "this policy is not exclusive" will require med recs for determination.
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What does MSP stand for and list when this happens: | show ๐
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show | Initial Enrollment Questionnaire (for opt initial enrollment in MC)
Common Working File - CMS file w/ pt elegibility & utilization data such as:
-PART A & B ENTITLEMENT & DED INFO
-DOB/DOD
-Benefit periods
-MSP info
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show | Medicare Secondary Payer Questionaire, form to determine if MC is primary or secondary.
asks about employment, accidents, etc.
Provider must obtain every 90 days for recurring OP accounts.
Must be retained by provider for 10 yrs.
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What does a provider have to do to terminate a patient relationship? | show ๐
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What does ALOS stand for and how to determine: | show ๐
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What is the midnight census and how to determine: | show ๐
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What does ADC mean and how to determine: | show ๐
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How do you determine percentage of occupancy? | show ๐
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How to calculate average number of patients seen per day (P)? | show ๐
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