Revenue Cycle
how many steps in the rev cycle?
10 steps
Medicaid, Medicare, Tri-care/Champus are considered what kind of health insurance plans?
Government plans
To be eligible for medicaid one must be...
age 65 or older
Disabled
ESRD end stage renal disease
Mother and father both has the child covered with insurance through their employers. What ranking rule do you use to determine which insurance is primary?
Birthday rule
A rule used to determine whose insurance is primary for a child covered under both parents' insurance. Both insurance carriers must follow the birthday rule. The parent whose birthday falls earliest in the calendar year becomes the primary insurance and the other would be secondary. If both parents are born on the same day, the parent whose insurance has been in effect the longest is the primary insurance.
What is an ABN form and what does it mean?
Advance Beneficiary Notice. A notice that a care provider should give a Medicare beneficiary to sign if the services being provided may not be considered medically necessary and Medicare may not pay for them.
The check-in process is part of what step of the Revenue cycle?
3
Anthem, Cigna, BCBS, Aetna are considered what kind of health insurance plans?
Commercial plans
How does a patient become eligible or active with Medicare part B benefits?
They must apply for it and pay monthly premiums in order to stay active with Medicare part B.
Husband has insurance through his employer and he is also covered by his wife's employer. Which insurance should is primary and which is secondary for his medical visits?
His insurance plan from his employer is primary and the insurance that he has from his wife's employer is secondary.
What is an Advance Directive used for?
An advance directive is a written instruction relating to the provision of healthcare when a patient is incapacitated. It may include appointing someone to make medical decisions, a statement expressing the patient’s wishes about anatomical gifts (i.e. organ donation), and general statements about whether or not life-sustaining treatments should be withheld or withdrawn.
The process of adjudication is what step of the revenue cycle?
8
What kind of medicare plan includes RX ?
Medicare advantage plan
What happens to patients who do not apply for Medicare part B benefits?
They have no cover for outpatient services.
The patient has two health plans. One is Aetna from her job and the other is Caresource Medicaid. Which insurance plan is primary and why?
Aetna. Medicaid is the payer of last resort.
What defines an informed consent?
Informed Consent - consent given in writing where by a patient acknowledges that they have been informed about the planned procedure including the risks involved. Informed consent is required for any operative or invasive procedure as well as for participating in any research protocol. In order for a patient or family to truly understand, they must be given a clear explanation by the provider of any proposed treatments or procedures including. (pg 28)
Collections is what step of the revenue cycle?
10
What information on an insurance card is used to identify a member?
Subscriber ID or Member ID #.
Is there a penalty for not applying for Medicare part B benefits or can the patient apply any time?
Yes there is a penalty and no they can not apply anytime, they need to wait for open enrollment.
Husband is 65 years of age and has traditional Medicare A an B benefits. He is also covered by his wife's Aetna health plan from her job. Which insurance ranking rule do you use to determine which payer is primary?
Working rule
When is an Implied Consent by Law form used?
Consent by law when a patient presents unconscious to the Emergency Department
What step of the revenue cycle is blamed the most for claims denials due to error entries?
1 preregistration
Subscribers can add whom to their insurance plan?
Spouse and Children.
What does Medicare part A benefits cover?
Inpatient services.
Husband is retired and covered by Medicare and his wife's Aetna GHP. He has ESRD and in his 32 month coord period. Which insurance plan is primary and why?
Medicare. After the patient's 30 month coord period, Medicare becomes primary to the GHP.
What is Implied Consent (in fact) ?
“consent by silence” as implied by no objection.