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Which are responsibilities a NAHAM member?
a. Admissions, Registration, Charting
b. Financial Counseling, Pre-Certification, Diagnostic testing
c. Guest relations, Information, Telecommunications
d. Scheduling, Benefits verification, nutrtional support
c. Guest relations, Information, Telecommunications
NAHAM members have which responsibilities: (select all that apply)
a. Admissions
b. Guest Relations
c. POS collections
d. Charting
a. Admissions
b. Guest Relations
The Revenue Cycle consists of which functions: (select all that apply)
a. Charge capture
b. Coding
c. Monitoring patients
d. Taking patient vitals
a. Charge capture
b. Coding
Typically a minor becomes emancipated when they:
a. marry
b. Give birth to or father a child (can give consent for that child but may require parental consent if still covered under a parent’s medical plan) (States vary on this).
c. No longer require parental guidance and financial support (some states require a doctrine of emancipation)
d. Are in the military
e. all of the above
e. all of the above
Guidelines for auto insurance are as follows, except:
a. If a patient has health insurance, the auto insurance would be primary.
b. If a patient has Medicare or Medicaid as their primary insurance, and the services are the result of an auto accident, the auto insurance would be primary.
c. Obtain the name of the insurance carrier, claim number, billing address, and adjuster's name and phone number if possible, at the time of registration.
a. If a patient has health insurance, the auto insurance would be primary.
The first contact with a patient is usually with a Patient Access Professional.
true or false
true
According to NAHAM, Patient Access Services responsibilities are:
a. Pre-admission services
b. Pre-certification of insurance
c. Point of Service collections
d. All of the above
d. All of the above
Some of the departments within Patient Access Services include:
a. Cafeteria
b. Financial Counseling
c. Pre-Service Clearance
d. Pharmacy
b. Financial Counseling
c. Pre-Service Clearance
list 2 types of consent
1.
2.
- Actual or Explicitly Expressed
- Implied Consent by Law
- Implied Consent (In Fact)
- Informed Consent
Employer group health plans (GHP) with greater than ____ employees, for patients over 65 who are insured by either their own or a spouse’s employer
a. 20
b. 25
c. 100
d. 50
a. 20
patient financial services/billing consist of all except
a. billing
b. collections and follow up
c. cash posting
d. scheduling
d. scheduling
The Revenue Cycle consists of which administrative functions. (fill in the blanks)
1.
2. Clinical Services
3. HIM/Medical Records
4.
Patient Access
Patient Financial Services/Billing
List at least 2 departments within the PAS
1.
2.
registration
pre-registration
scheduling
insurance verification
information desk
operator services
financial counseling
patien accommodation or bed control
pre-service clearance
mater person index search database services
Disabled patients under 65 who are covered by group health plan (GHP) insurance with more than ____ employees
a. 500
b. 100
c. 1000
d. 150
b. 100
In general, when adding a commercial insurance to a patient’s visit, the Patient Access staff should obtain all, except:
a. An ID number (or plan number, policy number, member number, employee number, insured number, social security number, etc)
b. employer phone number
c. The policyholder’s social security number and employment status
b. employer phone number
_________ is critical to the success of the Revenue Cycle.
a. accuracy
b. accountability
c. affordability
a. Accuracy
List at least 3 primary identifiers
1.
2.
3.
correct spelling of names
use of legal names
date of birth
social security number
previous names
List at least 2 secondary identifiers
1.
2.
address
gender
telephone number
List at least Self-Pay Insurances
1.
2.
discount programs
charity
auto insurance
workers compensation
no fault
List 2 types of Outpatient Care
1.
2.
ambulatory
clinic
emergency
outpatient observation services
priavte
same day surgery
Incomplete insurance information, non-covered services and untimely billing can cause a rejected claims or denial.
True or false
true
List at least 2 Governmental Insurance Plans
1.
2.
medicare
medicare advantage
medicaid
tricare/champus
state child health plan
indian health services
List at least 2 Commercial Insurances
1.
2.
anthem
blue cross
united healthcare
cigna
aetna
medical mutual
NAHAM responsibilities to Patient Access Services. fill in the blanks)
1. _______________ 7. _____________
2. Registration 8. _____________
3. _______________ 9. Guest Relations
4. ______________ 10. ____________
5. _______________ 11._____________
6. Scheduling
Admissions
Financial Counseling
POS Colletions
Benefit Verifications
Pre-Certifications
Telecommunications
Information
Physician Relations
List at least 4 level of care
1.
2.
3.
4.
acute inpatient care
acute psychiatric care
intermediate care
intensive care
long term care
sub-acute or post-acute care
respite care
hospice care