CRCR – ST EXAM REVIEW-with 100% verified solutions 2024-2025, Exams of Nursing

Download CRCR – ST EXAM REVIEW-with 100% verified solutions 2024-2025 and more Exams Nursing in PDF only on Docsity! CRCR – ST EXAM REVIEW-with 100% verified solutions 2024-2025 Dollars and Sense initiative (consistency, clarity, and transparency to patient financial communications) - 3 healthcare revenue cycle initiatives - Patient financial communications best practices - Best practices for price transparency - Medical account resolution Patient Financial Communications - ED if patient is having a medical emergency, financial conversation should occur during discharge. If it isn't an emergency it can happen at registration or discharge Patient Financial Communications - Advance of service financial discussions can occur via outbound, inbound contact, there should be reasonable attempt to have the discussion as early possible before financial obligation has occurred. Patient Financial Communications - Time of service (not ED) financial discussion can happen at registration or discharge so as not to disrupt the patient flow Patient Financial Communications - Routine and complex scenarios patients should be given the opportunity to request a patient advocate, family member, or other designee to help Patient Financial Communications - routine scenarios Routine: patients with insurance and ability to pay, discussions should take place between patient/guarantor and a properly trained provider rep Patient Financial Communications - complex scenarios Complex: uninsured, underinsured patients a financial counselor/supervisor should be involved Patient Share: - Patients should be told about the types of service providers (pathologists, radiologist, anesthesiologist, etc) who typically participate in the service. Patients should receive written list of service provider types upon request. Should be informed that actual costs may vary from estimates, depending on the actual services performed or timing issues related to other payments that may affect their deductible. - Patients should be asked if they are interested in receiving information about payment options or financial assistance programs. - Discussion should not interfere with patient care, and should focus on patient education Financial Counseling -Providers should have widely publicized toll-free number for patients to call to receive assistance, and address concerns -It is hard to focus on financial matters when urgent health matters happen at the same time. It is important to make it convenient and the appropriate time. -Provider should maintain a thread of pre-reg discussions and avoid repeated requests for the same information Prior Balances - Providers should have clear policies on prior balance policies that are available to the public. Providers should have technology that give financial reps current info about patient financial obligations. Balance Resolution Essential Elements of a Corporate Compliance Program - Have a plan - Follow the plan (Corporate Compliance Program, know what happens if you don't follow the plan) - Review the Code of Conduct to verify you the follow the plan. Chief Compliance Officer Role oversees the code of conduct. FERA (Fraud Enforcement and Recovery Act) of 2009 amended the False Claims Act (FCA) Closure of loopholes, and to enhance the ability of the gov't, whistleblowers and reporting individuals to identify and successfully pursue entities and individuals who improperly receive gov't funds. Corporate Compliance Policy (CCP) elements - Transparent - Clearly articulated Code of Conduct Code of conduct is the backbone of the orgs compliance program, is tailored to the orgs goals and objectives and industry focus. In easy to understand language, the code of conduct articulate those core activities to which the organization is committed. Benefits of the Code of Conduct Reduce weaknesses by helping employees and agents understand their roles and responsibilities while fostering an environment where concerns and questions are raised without feat of retaliation or retribution. Chief Compliance Officer (CCO) oversees Code of Conduct - High-level personnel - Reports to the board of directors/trustees as the CEO - Has limited responsibilities for other operational aspects of the organization. OIG responsibilities - Identify opportunities to improve program economy, efficiency, and effectiveness - Holding accountable those who do not meet program requirements or who violate federal laws - Annually publish a work plan of compliance issues and objectives that will be focused on throughout the following year OIG compliance objectives examples - Medicare payments for service dates after dates of death - Incorrect medical assistance days claimed by hospitals - I/P psychiatric facility outlier payments - Medicare payments for overlapping Part A I/P claims and Part B O/P claims - O/P and I/P stays under Medicare's Two-Midnight Rule Violations of the OIG Work Plan - Providers who are found to be in violation of CMS regulations are subject to Corporate Integrity Agreements. - Using the leverage of the previously mentioned legislative and regulatory changes, the gov't secured substantial fines and penalties (National Medical Enterprises/Tenet, National Health Labs, and the University of PA). They were entered into "forced" compliance program settlement agreements, which included not only fines and penalties, but also substantial requirements for auditing, monitoring, education, and ongoing reporting to the federal gov't. NPI - eliminated myriad of provider identifiers - 10-position, intelligence free numeric ID - Doesn't carry additional information about providers such as state, specialty. - Used in administrative/financial transactions - When and Identifier is reported on a claim for an ordering/referring/attending provider or for an operating/other/service facility provider, or for any provider that is not a billing, pay to, or rendering provider that id must be an NPI EIN (Employer ID Number) required under HIPAA, EIN assigned by the IRS to be used in standard transactions to id the employer of an individual described in a transaction, such as the transmission of enrollment or disenrollment information to a health plan. Any business required to furnish a taxpayer ID (meaning that wages are paid to one or more employees) must use the EIN as its taxpayer ID number. HIPAA Title II required the Department of Health and Human Services (HHS) to establish national standards for the security of electronic healthcare information and specifies a series of administrative, technical, and physical security - HINN - hospital Part A notification of noncoverage because the care is not medically necessary, not delivered in the most appropriate setting or custodial in nature. ABN requirements Part B approved CMS form to the beneficiary or the beneficiary's authorized representative. ABN form requirements Part B - Type used must be easy to ready and commonly used fonts - Type size must be large enough for an elderly person to ready, ideally 12 point or larger. - Ink color and paper color should provide high degree of contrast - Use of highlighting or shading text should be avoided. - Any information type or hand written on the form must legible and readable. - Be on the approved CMS form CMS-R-131 - Clearly identify the specific test or services that may not be covered - Provide the information used to determine that Medicare may not pay for the test/service - Identify the estimated costs of the test or service that may not be covered. - Be delivered in person to the patient or the patient's representative - Be provided to the patient far enough in advance to allow time for the beneficiary to make an informed decision - Be understood by the patient or patient's designee - Be signed by the patient or the patient's rep - Comply with the use of the form provided by CMS for this process Beneficiary Notices Initiative Medicare has implemented Beneficiary Notices Initiative (BIN). This initiative details 9 different types of financial liability notices required under both the traditional Medicare and Medicare Advantage programs. Two-midnight Rule In an effort to resolve that ambiguity, CMS addressed the issue of patient status in the FY 2014 IPPS final rule and finalized its "two-midnight" policy whereby the agency will generally consider hospital admissions spanning two midnights as appropriate for payment under the IPPS rule. In contrast, hospital stays of less than 2 midnights will generally be considered outpatient cases regardless of clinical severity. Medicare Secondary Payer (MSP) Since the beginning, certain payers have always been liable for payment of claims. In these cases Medicare does not make a secondary payment. The amounts paid by the primary payers are considered payment in full. Medicare Secondary Payer (MSP) - examples - Work-related injuries and accidents - workers comp - Black lung program - Veterans Affairs - Federal Grant programs - Public Health Service programs - Working aged - patient aged 65+ - Accident or other liability - Disability - End-stage Renal disease (ESRD) Correct Coding Initiative (CCI) - Ensures that the most comprehensive groups of codes, rather than the component parts are billed. - The program consists of edits that are implemented in the claim processing systems. CCI edits are incorporated within the outpatient code editor. The edits also check for mutually exclusive code pairs. Other coding initiatives include: Modifiers, exception, modifiers used for outpatient prospective payment system (OPPS) Modifiers Modifiers allow a hospital to indicate specific circumstances that has affected a procedure or service without changing its definition or code. The appropriate use of modifiers reduces the need for separate procedure listings on a bill by describing the modifying circumstance Modifiers - examples - Had both professional and technical component (applies to critical access hospitals using Method II reimbursement). - Was performed by more than one physician and/or in more than one location. - Was increased or reduced - Was performed more than once - Only part of the serviced was performed - An adjunctive service was performed - A bilateral procedure was performed - Unusual events occurred - premiums, and general revenues. - Has an annual deductible, and co-insurance, excluding diagnostic lab services - Co-insurance amounts for services paid under the OPPS are determined by Federal regulation and change as the OPPS payment system is updated each year by CMS. Medicare Part C Medicare Advantage, managed care plan that includes Part A and Part B, and may also include Part D Medicare Part D prescription drug coverage program, consists of private insurance plans that are reimbursed by the CMS. Beneficiaries may enroll in a prescription drug plan or a Medicare Advantage plan which may also include a prescription drug benefit. Tricare - Uniform Services Tricare brings together the healthcare resources of the uniformed services and supplements these resources with networks of civilian healthcare professionals, institutions, pharmacies, and suppliers. This provides uniform service members access to high-quality healthcare services while maintaining the capability to support military operations Tricare - Unique billing requirements - ER services are always billed separately from IP claims - Bills must be submitted for payment 1 year of service or discharge. If Tricare is the secondary payer, the claim must be submitted within 90 days of receiving payment from the primary payer - Tricare deducts a 10% penalty if prior authorization is not obtained when required. Tricare Prime Remote (TPR) managed care option similar to Tricare Prime for a active duty service members and their eligible family members who live and work in designated remote duty stations in the US (50 miles or an hour drive time from a military treatment facility) Tricare Prime Overseas managed care option for active-duty service members and their command-sponsored family members living together in a non-remote overseas locations. Tricare Prime Remote Overseas is available in designated remote overseas locations for active-duty service members and their families U.S. Family Health Plan an additional Tricare Prime option available through networks of community based, not-for-profit healthcare systems in 6 areas of the U.S. Tricare Young Adult managed care option for unmarried, adult children who have "aged out" of regular Tricare coverage. Individuals must be at least 21, but not yet 26. Not all who qualify for Tricare Young Adult qualify for the Prime option, they may qualify for Tricare Standard and Extra. Tricare Standard and Extra fee for service plan available to all non-active duty beneficiaries throughout the U.S. Includes OP deductibles, and co-insurance. The type of provider seen determines which option is used. When visiting a non- network provider, the standard option is used. The extra option is used when visiting a network provider. Tricare Standard and Extra Standard Overseas provides comprehensive coverage to active-duty family members, retired service members and their families, and all others who do not or cannot enroll in Tricare Prime Overseas. (Tricare Extra is not available in overseas locations.) Tricare Standard and Extra Reserve Select a premium based health plan available worldwide to Selected Reserve members of the Ready Reserve (and their families). Tricare Standard and Extra Retried Reserve (TRR) a premium based health plan for qualified retired Reserve members and survivors. Tricare Standard and Extra Young Adult Tricare for Life Tricare supplement to the Medicare program. This program is only available to Medicare-eligible individuals who are also enrolled in Medicare Part A and Part B benefits. point of service. plan that allows the member to select providers either in- network or out-of-network; beneficiaries are enrolled in an HMO but have the option to outside of the network for an additional cost. The PCP usually make referrals to other providers in the plan, but members can refer themselves outside of the plan and still get some coverage. HMO health maintenance organizations. health plan that has management responsibility for providing comprehensive healthcare services on a pre- payment basis to voluntarily enrolled persons within a designated population Commercial Indemnity Plans cover almost all services without authorization requirements BC/BS - BCBS are the oldest and largest family of health benefits companies and the most recognized in the health insurance industry. - Over 75 year ago, BC was started by insuring pre-paid hospital care to Texas teachers and providing physician care to lumber and mine workers in the Pacific NW. Self-insured a self-funded plan where the costs of medical care are borne by the employer on a pay as you basis. Typically include a stop-loss provision to protect the employer from catastrophic claim lossesRules governing self- funded plans fall under the federal Employee Retirement Income Security Act (ERISA) and are not controlled by state legislation. Liability coverage auto, home, business insurance that may include medical coverage clause. Healthcare facilities bill liability claims when the healthcare services are the result of an accident or injury In-Network and Out-of-Network A group of providers that have a contract with a health plan and agree to accept the plan's contracted rate as payment in full for services. If the patient goes outside of the network for care, they will likely pay more. Benefits of health plan networks Medical providers join networks to increase patient volume. These health plan networks offer policies to employers and individuals that steer business to in-network providers. The incentives include lower co- payments, lower deductibles, or lower premiums. Consumer Directed Health Plans (CDHP) CDHPS are typically attached to a health savings plan, which allows the employee to save pre-tax dollars in an account which can be used to pay for the higher deductible and co-insurance liabilities. An advantage of these accounts is there is no requirement to spend the funds within a given calendar year, and any remaining funds go with the employee should the employee leave their current employer. Medicare Advantage Plans Medicare Part C program created by the Prescription Drug, Improvement and Modernization ACT (MMA), which replaced the Medicare + Choice Program. Patients who join a Medicare Advantage plan generally get their entire Medicare-covered healthcare through the plan. HMO Point-of-service (HMOPOS) Plan an HMO plan that may allow the beneficiary to obtain some services out- of-network for a higher cost. Medicare Medical Savings Account (MSA) Plan a plan that combines a high-deductible health plan with a bank account. Medicare pays the plan and the plan in turn deposits money into the beneficiary's health spending account (usually less than the deductible). The beneficiary can use the money to pay for healthcare services during the year. Part D prescription coverage is not included; however MSA enrollees can join a stand-alone Medicare prescription drug plan (PDP and the Part D co-pays will count towards the out-of-pocket spending limit). Medicaid HMO Plans An HMO plan available only to patients enrolled in the state Medicaid program's medical benefits. In many states, people covered under the Medicaid program are required to join managed care plans. Medicaid managed care plans focus on preventive healthcare and provide enrollees with a "medical home" for themselves and their dependents. Managed Care tools Pre-certification/Pre-authorization , Referrals, Notification, Site-of-Service Limitations , Case Management, Discharge Planning Counting Inpatient Days A day begins at midnight and ends 24 hours later, this is called the midnight-to-midnight method of counting days. A part of the day, including the day of admission, counts as a full day. Coverage Extensions There are two specific statutory exclusions from coverage. One is that the services are deemed not reasonable or necessary. The other is that the items or services constitute custodial care, which is not a covered level of care. In addition, the following hospice service situations cannot involve the limitation of liability provision and require review and proper coordination of benefits assignment. Hospice SNF Patients Hospice benefits for a Medicare beneficiary who is in a skilled nursing facility (SNF) cover the professional management of the individuals hospice care but do not cover the room and board of the individual. Hospice Rate Structure With the exception of physician services, Medicare reimbursement for hospice care is made at one of four pre-determined rates for each day of hospice care. The four rates are prospective rates, and there are no retroactive adjustments other than statutory "cap" on overall payments and the limitation on payments for inpatient care. The rate paid for any given day varies depending on the level of care provided. Routine Home Care (hospice care) The same rate is paid per day regardless of the volume or intensity of service and is also paid when the patient is receiving hospital care for a condition unrelated to the terminal condition Continuous Home Care (hospice care) The continuous home care rate is divided by 24 hours to obtain the hourly rate. Inpatient Respite Care (hospice care) Payment for respite care may be made for a maximum of five days at a time including the date of admission but not including the date of discharge. This is payment to hospitalize the patient for a short period in order to relive the caregivers for a time period. Payment for the sixth and any subsequent day is paid at the routine home care rate. General Inpatient Care (hospice care) Payment at the general inpatient rate is made when general inpatient care is provided. Note: for levels A, C, and D only one rate applies to each day. For level B, the payment is determined based on the number of hours of continuous care furnished that day. Hospice Reimbursement: Overall aggregate payments made to a hospice are subject to a "cap amount", calculated by the (MAC) at the end of the hospice cap period. As of FY2017, the cap period will be aligned with the standard federal fiscal year (October 1 - September 30). Any payments in excess of the cap amount must be refunded by the hospice. The calculation refers to payment for services rendered during the cap period, regardless of the period when payment was actually received. Payment for Inpatient Services (hospice): payments to a hospice provider for inpatient care are subject to a limitation on a number of days of inpatient care furnished to Medicare patients. During the 12-month period from November 1 to October 31, the aggregate number of inpatient days for both general inpatient care and inpatient respite care may not exceed 20% of the aggregate total number of days of hospice care provided to all Medicare beneficiaries during the same period. If the MAC determines the inpatient rate should not be paid, the hospice provider will be paid at the home care rate for those days. Payment for Physician Services (hospice): • The MAC pays the physician the lesser of the actual charge or 100% of the Medicare reasonable charge. This payment is in addition to the daily rate. Payments for physicians' services are counted with the payments made at the daily payment rates to determine whether the hospice cap amount has been exceeded. • Patient care services rendered by an independent attending physician (not employed by or under contract with the hospice) are not part of the hospice benefit. Payment is made to the physician at 80% of the Medicare reasonable charge. This physician reimbursement is not counted in determining whether the hospice cap amount has been exceeded because services provided by an independent attending physician are not part of the hospice's care. Skilled Nursing Facility In addition to the acute inpatient care facilities, there are a number of post-hospital extended care service organizations and services. Post hospital care may be performed in several settings, including a SNF. Coverage for extended care services is a basic part of the Medicare Part A. Various portions of extended care services may also be covered under Part B. SNF Coverage Requirements: To qualify for post hospital extended care services under Medicare, the patient must have received medically necessary inpatient hospital services with a stay of at least three consecutive days in one or more hospitals. The day of admission, but not the day of discharge, is counted as a hospital inpatient day. Care in a SNF: Four factors must be met - The patient requires skilled nursing services or skilled rehabilitation services. - The patient requires skilled services on a daily basis. - Suppliers are paid at a base rate to include supplies with a separate charge for mileage. - Suppliers are paid at a base rate to include mileage and services but separate charges for supplies - Suppliers are paid at a base rate with separate charges for supplies and mileage. Ambulance Service and Payment Ambulance payment includes but is not limited to oxygen, drugs, extra attendants, and EKG testing - but only when such items and services are both medically necessary and covered by Medicare under the ambulance benefit. The policy of paying according to the medically necessary services means the payment is based on the level of service provided, not the on the vehicle used. Hospital-Based Physicians Hospital-Based Physicians (HBPs) are those physicians who perform services in a general acute-care hospital setting. While hospital based physicians might maintain private practices outside the hospital, at the hospital, that physician is responsible for providing critical services to patients admitted to the hospital. Common Billing Issue with HBPs A common billing issue with HBPs is based on the fact that they are contracted with the hospital but may not be contracted with a patient's health plan. The patient could be balance-billed for whatever amount the non-contracting physician charges above the health plan's reimbursement amount. Clinics In addition to rural health clinics, providers may operate provider-based clinics staffed by physicians and advance practice providers (APPs) such as physician assistants and/or nurse practitioners. CMS has issued specific regulations establishing the criteria that must be met to qualify for provider-based status. The advantage of provider-based status is the ability to bill both the technical component (facility) and the professional component (physician). Thus the patient could have two co-payments, one co-payment and one co-insurance payment, or another combination of patient portions. Telehealth Medicare Benefits and Billing Medicare pays for a limited number of Part B services furnished by a physician or APP via a telecommunications system. Examples of some Medicare eligibility telehealth services include: • Office or other outpatient visits (CPT codes 99201-99215) • Individual and group kidney disease education services (HCPCS codes G0420 and G00421) • Telehealth consultations, emergency department or initial inpatient (HCPCS codes G0425-G0427) Telehealth Medicare Benefits and Billing Medicare beneficiaries are eligible only if the originating site (location of patient at time of service) is in: - A rural Health Professional Shortage Area located either outside of a Metropolitan Statistical Area (MSA) or in a rural census tract - A county outside of a MSA Telehealth Originating Site An originating site is the location of the patient at the time the service is furnished. This could be an office of a physician or APP, hospital (including CAH), Rural Health Clinic, Federally Qualified Health Center, hospital- based or CAH-based Renal Dialysis Centers, Skilled Nursing Facilities and Community Mental Health Centers. Telehealth Distant Site Practitioner Practitioners at the distant site who may furnish and receive payment for covered telehealth services. This may include physicians, nurse practitioners, physician assistants, nurse-midwives, clinical nurse specialists, certified registered nurse anesthetists, clinical psychologist, clinic social workers and registered dietitians. General Health Plan Contracting Concepts - Percentage Discount health plans and providers can and do negotiate "percentage discount" agreements, resulting in the provider agreeing to a percentage discount of charges. General Health Plan Contracting Concepts - Per diem Per Diem literally means "per day," which in health care refers to a fixed amount per patient per inpatient day. The fixed daily payments do not vary based on the level of services used by the patient. General Health Plan Contracting Concepts -Diagnosis Related Group DRGs are a system of classifying inpatients on the basis of diagnoses for purposes of payment to hospitals. Patients are classified into clinically similar groups based on principal diagnosis, type of surgical procedures, presence of other medical conditions, or medical complications. Reimbursement for DRGs is made based on a prospectively set, predetermined, fixed payment amount based on the average resources used to treat the patient in that DRG (fee-for-service). For particular cases that are unusually costly, known outliers, the DRG payment is increased. This additional payment is designed to protect the hospital from large financial losses due to unusually expensive cases. Technical Denial missing or incomplete claim information and can be for a portion of care or the entire stay, Demographic errors, Incorrect/incomplete insurance information, No required pre-certification or pre-authorization, No continued stay authorization, Exceeded frequency limitations Clinical Denial - Diagnosis does not correspond to the procedure performed. - Service is deemed not medically necessary. Ex. Medicare requires the completion of an ABN for non-medically necessary care. - Carve-out days (clinical documentation to support care is missing). - Inappropriate level of care. - Healthcare Common Procedure Coding System (HCPCS) code is incorrect for procedure performed. Inpatient Reasons for Denials - Patient was billed as observation but should have been admitted and billed as inpatient. - Patient was admitted but documentation does not support medical necessity - Admission notifications not completed within health plan timelines. - Continued care in an acute setting is not supported by medical record documentation. - Focused reviews in a specific area that may be related to the use of observation status, or the use of anesthesia, etc. Outpatient Reasons for Denials • Duplicate bills, usually caused by re-bills or late charges, without the proper bill type code. • Missing auths • Wrong insurance plan code • Prior approval not obtained for new procedures or drugs • Care provided in non-covered setting (inpatient vs outpatient) • Medicare Secondary Payer issues • Inaccurate demographic or insurance information such as group number • Lack of appropriate support documentation required for billing, such as therapy notes • Overlapping inpatient and outpatient claims (where outpatient should be rolled into inpatient claim) • Invalid revenue or HCPCS codes - Patient not eligibility or services not viewed as medically necessary - Untimely filing - Missing physician numbers Recovery Audit Contractors: The mission of Recovery Audit Contractors (RAC) is to protect Medicare from fraudulent and abusive billing. The RAC's primary responsibility is to identify improper payments for Medicare Part A and B claims that have been paid by claims processing contractors. Medicare Waiver of Liability: Waiver of liability refers to a provision established by Medicare to protect beneficiaries and physicians from liability when services are denied as inappropriate or medically unnecessary. Medicare Appeal Provider Greater than $10,000 Any provider of services that has filed a timely cost report may appeal an adverse final decision received from the MAC. This appeal may be filed with the Provider Reimbursement Review Board if the amount at issue is $10,000 or more. Medicare Provision Knowledge: if the Medicare beneficiary had knowledge or should have had knowledge that the services billed for were not covered, the beneficiary is liable for paying for the services. If neither the beneficiary nor the hospital knew or reasonably could have been expected to know that the services were not covered, Medicare is liable for paying the claim. Medicare Provision liability: if the provider should have known and the beneficiary is protected from liability, then liability falls with the provider, and the hospital cannot bill the beneficiary for services other than deductible and co-insurance amounts, even though no Medicare payment has been made. Medicare Fee-for-Service: 5 Levels of Appeal 1. Redetermination by the company that handles claims for Medicare 2. Reconsideration by a Qualified Independent Contractor (QIC) 3. Hearing before an administrative Law Judge (ALJ) 4. Review by the Medicare Appeals Council (Appeals Council) 5. Judicial review by a federal district court National Policy: Where there is no National Policy, beneficiaries and providers may appeal to the local claims processing contractor. Where there is National Policy, beneficiaries and providers may appeal how contractors and health plans apply that policy to their individual cases Covers the most basic functions of a collector communication. (unusual times, place, hours, etc) Section 806: six specific practices prohibited. A debt collector may not engage in any conduct the natural consequence of which is to harass, oppress, or abuse any person in connection with the collection of a debt. Section 807: There are 16 deceptive or false representations that are prohibited in the collection practices. A debt collector may not use any false, deceptive, or misleading representation or means in connection with the collection of any debt. Without limiting the general application of the foregoing, the following conduct is a violation of this section. Consumer Financial Protection Bureau independent agency of the US government responsible for consumer protection in the financial sector. Its jurisdiction includes banks, credit unions, securities firms, payday lenders, mortgage-servicing operations, foreclosure relief services, debt collectors, and other financial companies operating in the US. Chapter 7: Straight bankruptcy is a court proceeding that liquidate the debtor's nonexempt property, pays creditors, and discharges the debtor from his/her debt (not exempted from discharge). Chapter 11: Debtor Reorganization. Permits debtor to work out a court-supervised plan with his/her creditors ("reorganization"), usually in the nature of a composition (reduction in debt), an extension (more time to pay off the debt), or a receivership (involving the continuing management of the debtor's business or property). Chapter 13: Debtor rehabilitation is a court proceeding that does not liquidate property nor discharge debts. Rather, debtor rehabilitation serves to reorganize a debtor's holdings and instruct creditors to look to the debtor's future earnings from payment. Drivers Standard Work: Standard work is like a recipe, when the right ingredients are used and the instructions are followed as planned the outcome is as expected and is consistent, time over time. We can use this same approach within the revenue cycle by leveraging standard work, effective, patient-centric processes that are applied time over time and result in exceptional patient experience, positive quality outcomes and expected financial results. Drivers Resources: What resources are available to manage an organizations revenue cycle can vary depending on staffing protocol, computer systems, and capital and discretionary budget allocations. As a result, there is no "secret formula" to what is needed, but managing the resources available is very important to keeping, and possibly decreasing the cost to collect. Drivers Automation: There are many tasks or actions that require a human tough, this is especially true when the activity includes a patient interaction. However, it is important to consistently review repetitive revenue cycle tasks that are currently being done manually to determine if there are options and opportunities to automate the activity, without compromising the patients experience or work quality.