Three process of the revenue management life cycle
What is front-end, middle, and back-end?
100
Compliance programs are used to prevent this. Penalties can be given whether it is intentional or unintentional.
What is fraud and abuse?
100
This accreditation organization is recognized by many state governments as a condition of licensure and receiving Medicaid reimbursement.
What is the Joint Commission?
100
The inappropriate or unauthorized misrepresentation of another's identity to obtain medical services or goods or falsify claims for medical services in an attempt to obtain money.
What is medical identity theft?
200
The purpose of the chargemaster maintenance is to target these three issues most often seen in hospitals.
What is correct, complete, and compliant coding?
200
Passed in 2005, this law aims at fighting Medicaid fraud and abuse.
What is Deficit Reduction Act?
200
The process by which government and nongovernment organizations evaluate educational programs, healthcare facilities, and individuals as having met predetermined standards.
What is certification?
200
There are two types of medical identity theft.
What is internal and external?
300
An electronic file that represents a master list of all services, supplies, devices, and medications charged for inpatient or outpatient services.
What is charge description master?
300
The organization that protects the integrity of the Health and Human Services programs as well as the health and welfare of program beneficiaries.
What is Office of the Inspector General (OIG)?
300
The Health Care Finance Administration (HCFA) was renamed in 2001 to this and is also an agency of HHS.
What is Centers for Medicare and Medicaid Services (CMS)?
300
Medical identity theft affects the victim's medical information and this.
What is financial information?
400
Lack of medical necessity, inappropriate utilization, non covered services (incorrect coding, unbundled codes) are a few of the most common reasons for this.
What are denials?
400
"A process for coding new procedures or unusual diagnoses" and "Identification of who is responsible for code selection" are necessary components for this.
What is coding compliance plan?
400
The Nursing Home Quality Initiative that was created in November 2002 by the CMS was aimed to give consumers an additional source of information about quality of nursing home care by providing a set of this.
What is Minimum Data Set?
400
This law created by ARRA/HITECH helps target medical identity theft.
What is HIPAA breach notification requirement?
500
The average number of days between the discharge date and the receipt of payment for services rendered is the method to calculate this. It is better for the organization to have a smaller number of days.
What is accounts receivable (A/R)?
500
The extrapolation method looks at a small sample of records and applies the correction in payment/reimbursement across large number of claims in a time period or service area when doing this process.
What is extrapolation method?
500
Licensure is performed this often and facilities must meet the minimum acceptable standards for operation.
What is annually?
500
The Breach Notification Rule requires covered entities and business associates to establish policies and procedures to investigate an unauthorized use or disclosure of PHI to determine if a breach occurred, conclude the investigation, and to notify affected individuals and the secretary of the HHS within this many days of date of discovery of the breach.