AAHAM CRCS STACK 3 and 4
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| What are the primary functions and responsibilities of Patient Access? | show 🗑
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| show | Pre-admission
Admission
In-house
At discharge
After Discharge
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| show | Preservice
Time of service
In-house
At checkout
Post svc
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| What does MOON stand for and describe | show 🗑
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| show | MC OP Obervation Notice
No more than 36 hours after observation begins, verbally and in writing.
MC pts and patients in psychiatric and critical access hospitals.
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| What are the rules for the Important Message from Medicare? | show 🗑
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| show | - prevent un-necc svcs/trmt
-evaluate safety/ability to live at home
-Obtain approp medical care
-secure supplies & equip
-obtain home care nursing svcs
-obtain assis with errands
-coordinate f/u
-discharge planning
-assist w/ appeals for denials
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| What does HINN stand for and describe | show 🗑
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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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| show | Initiation: Start of trmt, signed prior to svcs
Reduction: frequency/duration of care is decreased - only if pt wants to continue frequency knowing it won't be covered.
Termination: If beneficiary elects to continue trmt that MC deems no longer nec.
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| What is an ABN and what must it list? | show 🗑
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| What is the purpose of compliance rules in patient access area? | show 🗑
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| show | -Inpatient (admitted to a bed, expecting hospital care required. also called acute care. Highest level of care.
-Observation - still occupy a bed, but considered OP, monitoring an acute condition that is expected to either get worse or remedy.
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| Explain ER/ED and recurring/series levels of care: | show 🗑
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| Explain what LTC (level of care) stands for and describe: | show 🗑
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| show | Office: Practioner's place of business.
OP: Urgent care offices, IV therapy, pain management, wound care, Substance abuse rehab.
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| show | Skilled Nursing Facility
Must be inpatient in hospital 3 days (not including day of discharge)
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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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| show | Gen: Routine Labs, Diagnostic imaging, Medical trmt
Special: HIV + testing, surgery, anesthesia, non-surgical procedure with higher risk, radiation therapy, electroshock/psychiatric treatment, experimental proc., drug/alcohol disorders, blood transfusion
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| show | Actual/expressed - written or oral
Informed consent: required unless and exception is present (incompacity to understand)
Implied in fact: consent by silence, no objection
Implied by law: Pt is unconscious and cannot give consent
Parental/other
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| What does AOB stand for and describe | show 🗑
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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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| show | - treating or attending physician
- physician extender (PA, NP, etc)
- RN
- A student from an accredited health profession program
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| When and how can a medical record be released? | show 🗑
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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 🗑
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| What is a Non-Definitive LCD or NCD? | show 🗑
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| What does MSP stand for and list when this happens: | show 🗑
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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 🗑
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| What does ALOS stand for and how to determine: | show 🗑
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| show | refers to the number of pts in a hospital at a particular point in time, most commonly used:
Previous midnight census MINUS discharges PLUS admissions PLUS OR MINUS status changes = midnight census
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| show | Average daily census - average number of inpatients each day for a specific period of time:
Total number of patient days DIVIDED BY number of days in the period = ADC
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| How do you determine percentage of occupancy? | show 🗑
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| How to calculate average number of patients seen per day (P)? | show 🗑
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