A
What is the NCQA known for?
Providing guidelines on how a facility selects providers
Which act amendments provide healths health care benefits to the elderly and low income population?
Social security act of 1965
What is a facility charge?
A charge for resources used during a patients stay
What type of patient stays at the hospital for less than 24 hours?
Outpatient
What is observation care?
When patients need to be monitored closely to determine discharge status
What is the purpose of a utilization review department?
To make sure all health services provided to a patient are medically necessary
What is one area of the hospital that is considered outpatient?
Ambulatory surgery center
Who oversees the Medicare and Medicaid program for the federal government?
CMS
What is charge capturing?
The gathering of charges and charge documents from al departments for billing purposes
What does CDM stand for?
Charge description master
What is the referring physician?
The physician who "refers" the patient for admission
What is an authorization for release of medical records?
A consent to release medical information to third party payers
What is the assignment of benefits?
A constant for benefits or payment to be sent directly to the facility
What was the Hill-Burton act signed in regards to?
It provides funding for hospital construction
What does the abbreviation RA stand for?
Remittance advice
What does acute care mean?
A facility that provides medical care and treatment to patients who require care for their acute condition, illness, or injury
Who performs audits and investigates fraudulent activities to protect the integrity of the Medicare and Medicaid program?
OIG, office of inspector general
What is an advance beneficiary notice, or ABN?
Consent that identifies services not covered by patients insurance in which they will be responsible for payment
What is hospital size measured by?
The number of inpatient admissions possible
Who is responsible for controlling health care cost?
DHHS
When is it acceptable to code signs or symptoms?
When a diagnosis has not be established or confirmed by the provider at the conclusion of the outpatient encounter
What is not considered a professional service cost?
Room/board charge
What does SNF stand for?
Skilled nursing facility
What act states that facilities are obligated to provide emergency medical access to all, regardless of their ability to pay?
Emergency Medical Treatment and Labor Act
What does EOB stand for?
Explanation of benefits