Patient Access
Initial Application for Services; AOB; Privacy Act of 1974; NOP (HIPAA); MSP Requirements; Inpatient Documents; Advanced Directives-PSDA
What is Documents of Signature?
Additional insurance that may pay some medical charges not paid by your primary insurance.
What is Secondary Insurance?
Denial or revocation of the provider number application; suspension of provider payments; application of civil monetary penalties.
What are Administrative Sanctions?
Monitor and improve utilization and quality of care for Medicare beneficiaries.
What is Quality Improvement Organization (QIO) Program?
Original Medicare; Medicare Advantage Plan
What are Two Ways to Get Medicare Coverage?
Treatment received at a hospital, clinic, by someone who is not hospitalized
What is Outpatient?
An insurance plan that pays for preventive and other medical services provided by a specific group of participating providers for a fixed, prepaid premium. PMPM.
What is HMO?
Conducts an audit of the hospital every 39 months and of a laboratory every 2 years.
What is the Joint Commission?
Federal government's largest grant-making agency.
What is the Department of Health and Human Services?
Open Enrollment Date
What is October 15-December 7?
Cover HIV positive testing, electroshock or psychiatric treatment, experimental procedures, and treatment for drug/alcohol disorders.
What is Special Consent Forms?
Limits on the amounts non-participating providers can charge Medicare beneficiaries.
What is Limiting Charge?
Prohibits harassment or abuse in the collection process; use of false or misleading information in the collection process.
What is the Fair Debt Collection Practices Act (FDCPA)?
Previously called the Health Care Financing Administration
What is the Centers for Medicare and Medicaid Services?
Run by Medicare approved private insurance companies that must follow rules set by Medicare.
What is Medicare Advantage or Part C?
Place the focus on customer service; educated staff; pre-register patients whenever possible
What is Patient Access Goals?
A code used for billing that describes the patient's illness or diagnosis.
What is Diagnosis Code?
PPACA
What is Patient Protection and Affordable Care Act?
Department of Health and Human Services; Centers for Medicare and Medicaid Services
What are Federal Agencies?
Days 61-90
What is Co-Insurance Days?
Transitional point from the hospital to the home. To qualify, M'care requires a person to have been in a hospital for 3 consecutive days, not including day of discharge.
What is Skilled Nursing Facility?
Part of the bill that the provider has agreed not to charge the patient because of billing agreements they have with the patient's insurance company.
What is Contractual Allowance?
Kennedy-Kassenbaum Bill
What is HIPAA?
NIH; CDC; FDA; IHS; CMS; ACL; SAMHSA, HRSA
What are DHHS Divisions?
January 1-March 31
General Enrollment Period