Billing
Name 3 examples of items that are NOT covered by Medicare.
Cosmetic surgery - routine eye care/eyeglasses - hearing aids - dental - acupuncture - orthopedic shoes
This is the most common type of bankruptcy.
What is chapter 7?
The total number of patient days / total number of discharges
What is Average Length of Stay?
This is the Medicare deductible for Days 1-60 and is per spell of illness.
What is $1340
If both parents provide coverage for a child, the "birthday rule" states that which parent has the primary coverage?
What is the parent with the first birthday in the calendar year?
Name an example of when Medicare is a secondary payer
Services covered by work comp or Black Lung - care related to liability - Patients 65+ with group coverage (20+ employees)
This type of consent refers to consent by silence; the patient implies consent by not objecting.
What is Implied Consent - In Fact?
Previous Midnight Census - Discharges + Admissions +/- Status Changes
This is the Medicare deductible for days 61-90 (aka co-insurance days)
What is $335/day?
The "ICD" in ICD-10 stands for what?
What is International Classification of Diagnoses?
The "7" in a 711 TOB stands for what?
What is Clinic? (And for fun, break down the rest of it :))
Routine lab testing, diagnostic imaging, and medical treatment are all covered under this type of consent form.
What is General Consent form?
The average number of inpatients maintained in the hospital for each day for a specific period of time.
Number of Patient Days / Number of Days
What is Average Daily Census?
This is the Medicare deductible for Days 91-150 (lifetime reserve days)
What is $670/day?
This occurs when the bankruptcy is rejected by the courts.
What is dismissal?
This is the five-digit numeric code that identifies medical services and procedures - full wording, not abbreviated :)
What is Current Procedural Terminology?
Name 3 services that would require a Special Consent.
Any 3 of the following:
HIV testing, anesthesia, major/minor surgery, high-risk non-surgical procedures, radiation, electroshock therapy, experimental procedures, and treatment for drug/alcohol disorders
Census / Number of beds available
What is Percentage of Occupancy?
What is $0 - (No deductible or coinsurance)
Someone who avoids paying bills by changing addresses and failing to provide new address OR gives false information is this type of skip.
What is an intentional skip?
Name the two payment methods that CAHs are not subject to.
What are DRG and APC?
What is EMTALA? (And for fun, what does it stand for?)
The formula to calculate AR days is this.
What is AR / Average Daily Rev
This is the Medicare deductible for SNF days 21-100.
What is $167.50?
Name 2 services that Medicare covers on an annual basis.
Flu vaccine - Pneumo vaccine - Behavior counseling - glaucoma screening