Patient Financial Communication
What is the main objective of financial communication with patients during the pre-service process?
To ensure patients understand their financial responsibility, including copayments and deductibles.
What is a Silent PPO in the context of health plan contracts?
A health plan that reimburses providers at a rate lower than the contracted rate without informing the provider.
What is the purpose of using Key Performance Indicators (KPIs) in the revenue cycle?
To measure the effectiveness and efficiency of revenue cycle processes, such as billing, collections, and payment.
What is one key aspect of HIPAA compliance in the revenue cycle?
Ensuring that patient information is kept confidential and is only shared with authorized individuals.
What is the first step after a patient is discharged in the post-service segment?
The discharge information is entered into the system, including the disposition code.
Which federal regulation requires that healthcare providers disclose the cost of services to patients before they receive care?
The No Surprises Act (NSA).
In a Per Diem payment model, what is the payment based on?
A fixed amount per patient per day of service.
What is the MAP Key® in revenue cycle management?
A performance metric used to track the most critical aspects of the revenue cycle, such as the number of days in accounts receivable.
What does the False Claims Act prohibit in healthcare billing?
Submitting false or fraudulent claims for payment to Medicare, Medicaid, or other federal healthcare programs.
How are medical records involved in the post-service billing process?
Medical records are reviewed to ensure all necessary codes are entered for the services provided.
What is the role of financial counselors in patient financial communication?
To assist patients in understanding their financial responsibility and explore payment or financial assistance options.
What is the key difference between an HMO and a PPO?
An HMO requires patients to choose a primary care physician, while a PPO allows patients to see specialists without a referral.
What does the "Days in A/R" KPI measure?
The average number of days it takes for a healthcare provider to collect payment after a service is rendered.
What is the purpose of a Corporate Compliance Program?
To prevent and detect violations of laws and regulations, ensuring that healthcare providers follow ethical and legal standards.
What is one critical task in post-service billing?
Applying billing edits to ensure that the charges align with the patient’s verified health plan benefits.
What is one of the best practices for patient financial communication during time-of-service?
To ensure the financial discussion is conducted in a private and respectful manner, without disrupting patient care.
What is one major shift happening in healthcare payment models as discussed in the curriculum?
A shift from volume-based payments to value-based payments, focusing on patient outcomes rather than the number of services provided.
What is a common challenge in meeting revenue cycle KPIs?
Inaccurate or delayed patient information that leads to errors in billing and longer accounts receivable cycles.
What is the role of the Office of Inspector General (OIG) in healthcare compliance?
The OIG enforces regulations and conducts investigations into healthcare fraud, waste, and abuse.
What happens after billing edits are resolved in the post-service process?
The bill is submitted to the health plan for payment.
What is a critical factor when communicating financial information to patients in the Emergency Department (ED)?
Financial discussions should occur only after the patient has been screened and stabilized, in compliance with regulations.
What does a Diagnosis Related Group (DRG) payment model classify?
It classifies inpatient stays based on the diagnosis and procedures performed, which determines the payment amount.
How can understanding KPIs improve patient satisfaction?
By ensuring timely and accurate billing, leading to fewer patient billing complaints and better financial communication.
What is one of the ethical considerations when dealing with uninsured or underinsured patients?
Ensuring that financial discussions are conducted with compassion and that patients are informed about financial assistance options.
How is a zero-balance achieved in post-service financial care?
Payments are received from the health plan and posted to the patient’s account, resulting in a zero balance if no further payments are owed.