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Other Departments I
Other Departments II
Continuum of Care I
Continuum of Care II & Physician Office
Miscellaneous Review
100
This department is responsible for all patient medical records and has a responsibility to protect the legal interests of the patient and the provider.
What is HIM, or Health Information Management?
100
It is not unusual for this person to also serve as the organization's privacy officer.
What is the HIM director?
100
This philosophy looks at the healthcare system as a whole and looks at linkages to connect patients leaving acute care services with post-acute facilties and services for transition to home or into residential care.
What is a continuum of care philosophy?
100
This person determines the need for service and must write the order.
Who is the physician?
100
This is a system of classifying inpatients on the basis of diagnosis for the purposes of payment to hospitals.
What is the Diagnosis Related Group system, or MS-DRG?
200
This department supports and assists the utilization of technology to operate the health care facility.
What is Information Services or Information Technology
200
This planning includes an estimate of how long the patient will be in the hospital, what the expected outcome will be, whether there will be any special requirements on discharge, and what needs to be facilitated to effectively dicharge the patient in the appropriate timely manner.
What is discharge planning?
200
This type of facility is an institution that is primarily engaged in providing skilled nursing care and related services or rehabilitation services for the rehabilitiation of injured, disabled, or sick persons.
What is a Skilled Nursing Facility, or SNF?
200
This must include the following information to be considered valid: the date, a valid diagnosis, the patient's name, the physician's name and signature, and a description of the test or services being ordered.
What is the order?
200
This general term is used to describe healthcare benefit payments and is used to identify that for benefit plans there are three parties in the transaction: the patient, the provider, and the third-party (insurance plan, employer, etc.) that is responsible for payment of the covered services.
What is Third-Party Reimbursement?
300
This person monitors the case through the course of the patient's stay to ensure all services are provided on time and in the proper sequence, education for the patient and family is complete, and home services are ordered when applicable.
What is the Utilization Management (UM) nurse?
300
The purpose of this function is to monitor progression of high resource consumptive cases to help ensure effective utilization of resources durign the care of the patient and maximize patient outcomes.
What is case management?
300
This type of residence is designed for adults who need help with everyday tasks and is a combination of housing, personalized support services, and healthcare.
What is assisted living?
300
This department or location is typically responsible for obtaining any necessary pre-authorizations.
What is the physician's office?
300
This is a typical insurance provision that determines the responsibility for primary payment, and helps to avoid duplicate reimbursement for the same medical services.
What is Coordination of Benefits?
400
The responsibilities of this person include focusing on coordinating patient care and helping to ensure the patient is moved from one point in the care process to the next point. He/She also maintains routine contact with the insurer, making sure all required information is provided and all needed approvals are obtained.
What is the case manager?
400
These departments have the primary responsibility of of preparing and serving the patient, but a number of their activities support the revenue cycle process as well, including entering the charges in a timely manner and documenting the care delivered on the patient's chart.
What are clinical service departments?
400
This is medical equipment that is prescribed by a doctor for use in the home.
What is durable medical equipment, or DME?
400
This type of service is generally provided at home to terminally ill patients.
What is Hospice care?
400
This is the transaction set that is used to respond back to the provider's elegibility inquiry.
What is the 271 transaction?
500
This must be in place to make sure that systems operate effectively, and involves reviewing variance reports to continually ensure the integrity of systems.
What is continual monitoring?
500
This department is typically responsible for compliance with state and federal reimbursement reporting requirements.
What is decision support and cost reporting?
500
This type of written agreement with one or more participating hospitals is required for a SNF to participate in the Medicare program.
What is a transfer agreement?
500
In order to qualify for coverage under the Medicare program for this type of care, the patient must be certified by the physician to be confined to his/her home, and a place of residence may be the patient's own dwelling, an apartment, a relative's home, a home for the aged, or some other type of institution that is not a hospital or SNF.
What is home health services?
500
This is a method of payment to healthcare providers whereby a fixed amount is paid per enrollee to cover a defined set of services over a specified time regardless fo the actual services provided.
What is capitation?