Admitting & Registration
Who is the person that is ultimately responsible for paying the patient’s bill
Guarantor
The individual who carries the insurance coverage.
Who is the subscriber?
Fraud and abuse, billing practices, Antitrust, quality of care, managed care, bribes and improper payments, conflicts of interest, environmental concerns, and copyright and software licensing.
What are compliance issues?
A non-invasive test that is used to reflect underlying heart conditions by measuring the electrical activity of the heart.
What is Electrocardiogram?
The dollar amount that an insured is legally obligated to pay for services by a provider.
What is Patient Liability?
Consent given in writing or verbally by patient or guardian.
What is Actual or
Explicitly Expressed Consent?
A fixed amount the beneficiary pays for health care services, regardless of the actual charge; the amount is designated as the patient’s responsibility.
What is a co-pay?
Fraud committed or attempted using identifying information of another person without authority.
What is identity theft?
An x-ray of the breast in a device that compresses and flattens it.
What is a mammogram?
Treatment received by a patient in a hospital or clinic. The patient does not require hospitalization
What is Our Patient Care?
Approval from third party payors to provide specified care in a particular setting; written or electronic assurance that the services provided will be covered under the terms of the patient’s health care plan.
What is Payor Authorization?
To inform the patient that Medicare may not consider the health services being provided as medically necessary and that there is a good possibility that Medicare will not pay for the service provided and the patient may be billed for the service.
What is the purpose of the
Advance Beneficiary Notice?
The obligation of an employee to let management know of suspected violations in organizational policies, or federal or state laws.
What is the duty to report wrong doing?
A blood draw.
What is venipuncture?
Services provided that is never expected to result in cash flow
What is charity care?
Validating with third party payors that a given plan is active and ascertaining the patient’s deductible, co-pay and limitations
What is Verification of Benefits?
A fixed sum that a beneficiary must contribute towards the cost of their health care before insurance benefits begin.
What is a Deductible?
What is the act of complying with a request, demand or regulation?
Corporate Integrity
Partial or complete loss of consciousness.
What is syncope?
A program for children whose patient have too much money to be eligibility for Medicaid, but not enough to buy private insurance.
What is CHIP?
average length of stay; a metric calculated by dividing the total
number of patient days by the number of discharges.
What is ALOS?
a rule to determine coordination for benefits for a child covered by both parents; it dictates that the parent with the first birthday in the calendar year will provide the primary coverage; if both parents happen to have the same birthday, the plan that has covered a parent longer pays first.
What is the birthday rule?
Health Insurance Portability and Accountability Act of 1996
What is HIPAA?
High, excessive, beyond normal.
What is hyper?
Also known as Utilization Review, An area that performs critical tasks during registration and a patients stay, such as reducing unnecessary admissions, managing the approved length of stay; ensuring an appropriate level of care
What is Case Management?