Show:
Types of Patients & Scheduling
Pre-Registration
Ins. Verif. & Managed Care
Registration
Fin. Couns., payments & quality
100
Scheduled Inpatient, Scheduled Outpatient, and Recurring Series
What are the three types of scheduled patients?
100
Medicare Secondary Payor Screening
What is the screening process that is used to determine whether Medicare is primary or secondary when a patient has additional coverage?
100
Verify eligibility status, Obtain benefits, Confirm Coordination of benefits, Identify possible out-of-pocket liabilities, Document maximum out-of-pocket, Obtain pre-auth/Pre-cert requirements, Refer the patient for financial counseling
What are the seven steps of insurance verification?
100
This is the act that requires hospitals to provide a medical screening exam and stabilizing treatment to every person presenting to an Emergency Department?
What is EMTALA?
100
True self pay, and self-pay balance after insurance
What are the two types of self pay patients?
200
SKilled Nursing, Hospice, Home Health, DME, and Clinic Patients
What are several examples of "Other Patient Types"?
200
Do not read the information to the patient, but have the patient provide key information to eliminate the possibility that the patient simply agrees without listening.
What is the most accurate way to validate patient information?
200
This Medicare benefit provides coverage for inpatient hospital services, skilled nursing care, and home healthcare.
What is Medicare Part A?
200
The physician who wrote the order for service and is the physician in charge of the patient's care.
What is the attending physician?
200
This process has benefits that include decreased bad debt, lower accounts receivable levels, more cash, and a decreased effort by patient accounting staff to attempt to resolve patient balances.
What is the process of collecting patient liability payments at the time of service?
300
Patient full legal name, date, test or service, diagnosis, name of ordering provider, and signature of ordering provider
What are the data elements required by Medicare for an order to be considered valid?
300
Returned mail, Insurance denials, Duplicate MPIs
What are some of the consequences of improper or incomplete pre-registration?
300
Plans that have agreements with certain doctors, hospitals, and healthcare providers to give a range of services to the plan members at a reduced cost.
What are managed care plans?
300
This status allows the physician time to determine if admission is necessary, reduce denials for unnecessary admissions, and ensure that some payment is received for services rendered.
What is observation status?
300
Demographic, Income, Assets, and Expenses
What are the categories of information that are considered when determining a patient's eligibility for financial assistance?
400
The unique number assigned to each patient, used to link individual episodes of care to one patient within the system.
What is an MPI# or CPI#?
400
Disability rules do not apply to beneficiaries age 65 and older.
Why is it important to identify the age of a Medicare beneficiary?
400
270/271 transactions
What are the standard transaction sets for electronic healthcare eligbility inquiry (270) and benefit responses (271)?
400
Durable Power of Attorney for Healthcare, and Living Will
What are the the two types of advance directives?
400
Billing, Physician, Case Review, and Legal Issues
What are some of the areas impacted by patient access quality?
500
Specific service, Estimated Cost, Date of Service, non-covered reasons, and patient's choice and signature.
What must be on the ABN?
500
Complete patient demographics, complete guarantor information, Emergency contact, Complete insurance information, and Complete insured (subscriber) information.
What are the components of a comprehensive pre-registration data collection program?
500
Percentage discount, DRG, APC, Case Rates, Per Diem Payments, Package Pricing, Capitation
What are examples of the different managed care discounted payment models?
500
April 14, 2003
What is the date that HIPAA privacy rules went into effect?
500
Over 40% of this information is captured by patient access services.
What is the amount of information on the UB-04 claim captured by patient access services?