CHAA Exam QUESTIONS WITH COMPLETE 100% VERIFIED SOLUTIONS 2024/2025, Exams of Business Administration

Download CHAA Exam QUESTIONS WITH COMPLETE 100% VERIFIED SOLUTIONS 2024/2025 and more Exams Business Administration in PDF only on Docsity! CHAA Exam QUESTIONS WITH COMPLETE 100% VERIFIED SOLUTIONS 2024/2025 CHAA Certified Healthcare Access Associate NAHAM The National Association of Healthcare Access Management AIDET Acknowledge, Introduce, Duration, Explanation and Thanks Active Customer Feedback occurs when the provider requests information from the patient. Ex. Customer surveys, Customer comment cards and Customer callback programs Passive Customer Feedback Is the formal and informal process of obtaining and responding to patient compliments and concerns. Ex. Reviewing letters from patients and families and Conversations with patients/families Types of Surveys -Face to face -Telephone survey -Mail-in questionnaire -E-mail -Patient portal -Secret shopping When initiating a patient satisfaction survey, it is important to determine: -What data measurements are required -What data measurements are important to the organization's decision-making process -What data measurements are important to day-to-day management HCAHPS (also known as Hospital CAHPS) Hospital Consumer Assessment of Healthcare Providers and Systems and is a standardized survey of hospital patients that will capture patients' unique perspectives on hospital care for the purpose of providing the public with comparable information on hospital quality. The purpose of any quality improvement program is to: -Collect data -Analyze data -Initiate education or remedial action -Evaluate actions TJC The Joint Commission (TJC) is an independent, not-for-profit organization that evaluates and accredits more than 21,000 healthcare organizations in the United States3. TJC evaluates hospitals, healthcare networks, managed care organizations and healthcare organizations that provide home care, long-term care, behavioral health care, and laboratory and ambulatory care services. TJC was founded in 1951 and is considered the nation's oldest and largest standards-setting and healthcare accrediting body. Its mission is "to continuously improve healthcare for the public, in collaboration with other stakeholders, by evaluating healthcare organizations and inspiring them to excel in providing safe and effective care of the highest quality and value." The Joint Commission, requires healthcare organizations to identify and report on quality improvement initiatives. TJC defines quality control as: The performance processes through which actual performance is measured and compared with goals, and the difference is acted on. TJC defines quality assurance/improvement as: An approach to the continuous study and improvement of providing healthcare services to meet the needs of individuals and others. TJC defines performance improvement as: The continuous study and adaptation of a healthcare organization's functions and processes to increase the probability of achieving desired outcomes. KPI Key Performance Indicators KPIs generally monitored in Patient Access -Pre-registration percentage -Wait times: during scheduling and arrival -Accuracy rate -Upfront collections/point-of-service (POS) collections -They are less damaging to skin than soap and water, resulting in less dryness and irritation -They require less time than hand washing with soap and water -Bottles/dispensers can be placed at the point of care so they are more accessible PPE Personal Protective Equipment, "specialized clothing or equipment, worn by an employee for protection against infectious materials." OSHA Occupational Safety and Health Administration CS1. Under Title III of the Americans with Disabilities Act, hospitals are required to: a. Provide information as to where restrooms are located. b. Provide patients and families all documentation for the admission. c. Provide resources to eliminate barriers in communication. d. Ensure all patients are accommodated for admission. C CS2. What is not important when initiating a patient satisfaction survey? a. What data measurements are required b. What data measures are important to day-to-day management c. What data measures are important to the organization's decision-making process d. What data measures are needed to care for the patient D CS3. Which is not a purpose of any quality improvement program? a. Collect data b. Analyze data c. Blame someone for the mistake d. Evaluate actions C CS4. Which of the following is not a patient satisfaction survey: a. CMS survey b. JD Power c. Press Ganey d. Post-service telephone call to patient A CS5. Communication is: a. Providing a newspaper to the patient or family b. Exchanging information with the patient c. Sharing the telephone with the patient d. Giving a patient a prescription B CS6. Which is not a KPI in Patient Access? a. Accuracy rate b. CLABSI rate c. Patient satisfaction score d. Pre-registration rate B CS7. HEAT stands for: a. Help the patient, explain the situation, apologize, thank the patient b. Hear the patient out, explain the situation, apologize, take responsibility for actions c. Hear them out, empathize with the customer, apologize, take responsibility for actions d. Hear them out, empathize with the customer, amend the situation, thank the patient C CS8. All of the following are ways we communicate, except: a. Body language b. Eating c. Talking d. Facial expressions B CS9. What are the three steps to communication? a. Decipher, transmission, receiving b. Encoding, transmission, sharing c. Encoding, transmission, decoding d. Decipher, receiving, transmitting C CS10. Compassion and respect can be demonstrated in all of the following ways, except: a. Smiling b. Making eye contact c. Calling the patient "Dear" d. Greeting the patient B Accreditation Defined as "a self-assessment and external peer assessment process used by healthcare organizations to accurately assess their level of performance in relation to established standards and to implement ways to continuously improve." Accreditation is a review process conducted by an independent third party that an organization participates in to show their ability to meet or exceed established industry standards and regulatory requirements. In healthcare, accreditation reflects an organization's dedication to patient care, high standards and an extraordinary patient experience. There are several accrediting bodies in healthcare, including The Joint Commission (TJC), Healthcare Facilities Accreditation Program (HFAP) and DNV-GL. Acute care Medical attention given to patients with conditions of sudden onset that demand urgent attention or care of limited duration when the patient's health and wellness would deteriorate without treatment. The care is generally short-term rather than long-term or chronic care. Acute Inpatient Care A level of healthcare delivered to patients experiencing acute illness or trauma. Acute care is generally short-term (<30 days). Advance Beneficiary Notice (ABN) Written notice issued to a fee-for-service (Original Medicare) beneficiary before furnishing items or services that are usually covered by Medicare but are not expected to be paid in a specific instance for certain reasons, such as lack of medical necessity. Advance Directive/Living Will Also known as a medical directive, healthcare directive or a living will, a legal document in which a person has outlined what they would like to be done if they are no longer able to make decisions for themselves due to incapacity or illness. Ambulatory Services/Same-Day Surgery Patient receives surgical treatment and is discharged from the facility within four to six hours of procedure. Ambulatory services can occur in an outpatient hospital department or in a freestanding ambulatory care facility. Ancillary Services Physician refers patients for scheduled and non-scheduled services such as radiology, laboratory, and/or other services that are performed in a hospital or clinic setting. Patients leave the facility once the services are completed. Anti-Kickback Statute Anti-fraud federal criminal statute that prohibits offering or exchange of anything of value in exchange for healthcare business referrals, including cash, rent, expensive hotel stays, etc. Authorization Requirement Certain services need authorizations while other procedures might not. Some insurance companies require a CPT code, so make sure you have that available. Batch Processing Execution of a series of jobs in a computer program without manual intervention; it is used to help maximize the use of computer resources and stabilize response time by performing system-intensive Federal law targets fraud against the government. "Whistleblower's"/qui tam provision allows non- government individuals to "blow the whistle" in good faith on fraud against the government who may receive up to 30 percent of any recovered damages. HCAHPS Also known as Hospital CAHPS, it stands for Hospital Consumer Assessment of Healthcare Providers and Systems and is a standardized survey of hospital patients that will capture patients' unique perspectives on hospital care for the purpose of providing the public with comparable information on hospital quality. Health Exchange Health Insurance Marketplace or "Exchange" — organizations that facilitate structured and competitive markets for purchasing health coverage. Health Information Technology for Economic and Clinical Health Act of 2009 (HITECH) Federal law stimulating the adoption of electronic health records and providing financial incentives for demonstrating meaningful use; also expanded HIPAA security and privacy rules and increased penalties; established data breach notification rules. HITECH added data breach notification rules and increased penalties and fines to ensure that any EHR technology created under HITECH does not compromise the HIPAA security and privacy laws. Health Insurance Portability and Accountability Act of 1996 (HIPAA) Originally focused on regulations related to health insurance portability; focused on administration simplification and reduction of cost through the protection and standardization of electronic and financial records. Most known for the privacy rule and security rule, these rules defined standards for healthcare and protected healthcare information (PHI). Healthcare Facilities Accreditation Program (HFAP) An accrediting organization tied to Medicare Conditions of Participation Coverages. HITECH Omnibus of 2013 This update to the HITECH Act revised provisions that focused on an individual's right to request restrictions on the disclosure of PHI (restricted disclosure) and on an individual's right to access his or her PHI stored in an EHR. Hospice A non-profit organization dedicated to patients and families facing serious illness or death. Hospice provides a support system to patients and families who choose to share their last days together in the comfort of their home or hospice designated facility. Hospice provides a wide range of services that include: coordination of care with the patient's primary care physician, skilled nursing visits, spiritual counseling and social worker support. The hospice staff are an interdisciplinary team who coordinate an individualized plan of care for each patient that is directed by the Primary Care Physician. Hospice care is a covered service under the Medicare program. Icon A graphic symbol for an application, file or folder. Important Message from Medicare (IMM) IMM is a form given to all Medicare beneficiaries who are inpatients in participating hospitals explaining their rights and what to do if they feel they are being discharged early. It explains: -Rights as hospital patients, including the right to all the hospital care needed and follow-up care after discharge -Advises beneficiaries about what to do if they feel they are being discharged early and provides the phone number for the PRO (Peer Review Organization). Beneficiaries may remain in the hospital without being charged while the case is being reviewed. Hospitals cannot force beneficiaries to leave while their case is being reviewed. Insurance eligibility The person entitled to benefits and is covered. The date they became eligible for the plan is important to know since information can change from month to month along with the termination date of coverage. Level of Service The type of care a patient need for their stay. There are three levels of service: Intensive Care (ICU), step down, floor, observation and outpatient. Lifetime Maximum What is their lifetime maximum? Many payers have a calendar year and a lifetime maximum limit on benefits paid. Once the maximum has been reached, the benefits have been exhausted. There are no more funds available for coverage of any further services. Long Term Care Generally provided to the chronically ill or disabled in a nursing facility or rest home. Among the services provided by nursing facilities: 24-hour nursing care, rehabilitative services such as physical and occupational therapy and speech therapy, as well as assistance with activities of daily living. Coverage for nursing facility care is available under both the Medicare and Medicaid programs. Medicare beneficiaries are eligible for up to 100 days of skilled nursing or rehabilitative care. Medicaid coverage is available for those who have exhausted their own resources and require public assistance to help pay for their care. Meaningful Use (MU) Part of the HITEACH Act. An incentive program established to provide monetary incentives for the adoption and meaningful use of health information technology and qualified electronic health records. Meaningful Use sets specific objectives that eligible professionals (EPs) and hospitals must achieve to qualify for CMS Incentive Programs. Medicare Medicare provided health insurance for over 55 million people in 2015, approximately 46 million were aged 65 or older. Medicare provides healthcare for those over 65, as well as younger people with disabilities. Medically necessary According to Medicare.gov, "medically necessary" is defined as "healthcare services or supplies needed to prevent, diagnose or treat an illness, injury, condition, disease or its symptoms and that meet accepted standards of medicine." Medicare Administrative Contractor (MAC) A private healthcare insurer that has been awarded a geographic jurisdiction to process Medicare Part A and Part B medical claims for Medicare Original beneficiaries. Medicare Outpatient Observation Notice (MOON): A form given to Medicare beneficiaries to inform them of their outpatient observation status and to explain to them what that may mean financially. The MOON informs patients that they may have: -A co-payment -20% co-insurance for services after their yearly deductible -Their coverage and payment for aftercare may be affected (skilled nursing home, Medicaid, MA and medications) Medicare Savings Programs A program in which Medicaid pays Medicare premiums, deductibles and/or coinsurance costs for beneficiaries eligible for both programs. When a patient has this program, they are referred to as being dual eligible. Medicare Secondary Payer (MSP) questionnaire Medicare-required questions to determine if there are any other payers or situations that may pay primary to Medicare. An MSP questionnaire must be completed by the patient or their designated Power of Attorney (POA) or legal representative on all Medicare Original patients each time a service is provided. Since the answers to these questions can change from visit to visit, Medicare mandates that the questions be asked each time. Never assume the answers nor copy them from a previous case — the questions must be asked each and every time. Medicare Two-Midnight Rule CMS rule stating that for a hospital admission to be paid for under Medicare Part A, the patient stay had to cross two midnights. Anything less than two midnights is paid for under Medicare Part B. Minimum Necessary Standard Protected health information (PHI) Any protected health information (PHI), as identified under HIPAA, that is produced, saved, received or transferred. Recovery Process of restoring data that has been accidently lost, corrupted or made unavailable, typically from an external storage system used for back-up. Recurring Services Physical therapy, occupational therapy, speech therapy, cardiac rehabilitation or pulmonary rehabilitation that occurs over time based on a clinician's order and evaluation by the clinical staff before and during the course of care. Respite Care Short-term care provided at home, in a long-term care facility, at a community based center, or in a hospital when another setting is not available. Respite care allows families caring for elders or other mentally or physically dependent family members time off in their care-giving responsibilities. This type of care is not reimbursable through Medicare or Medicaid. Restricted Disclosure Defined in the HITECH Omnibus of 2013, a patient's right to restrict PHI disclosure. Server A central computer dedicated to sending and receiving data from other computers on a network. Specialty Clinics A patient is seen for specialized medical or surgical services and is discharged following treatment or care. This could be for a series of recurring visits based on the duration of care according to the physician's order. Telephone Consumer Protection Act (TCPA): A federal law regulating the use of prerecorded messages and auto-dialers; safeguards consumer privacy by restricting unwanted telemarketing communications. The Joint Commission (TJC) An independent, not-for-profit organization that evaluates and accredits more than 21,000 healthcare organizations in the United States. The Patient Protection and Affordable Care Act of 2010 (PPACA) The Affordable Care Act (ACA), or "Obamacare," included reforms to affordability, quality and availability. It aimed to greatly increase the amount of Americans who have access to affordable health insurance; provided assistance for those with pre-existing conditions; extended dependent coverage up to age 26; required coverage of preventative services and immunizations; eliminated lifetime limits on benefits; and expanded Medicaid coverage to more low-income Americans. The Stark Law A group of several federal laws that prohibit physician self-referral. TRICARE A healthcare program for military active, reservists, and retirees and families. Active-duty service members are automatically enrolled in TRICARE. Retirees and their dependents can enroll in TRICARE but may have to pay for the cost of coverage. -Tricare is secondary to all other insurance plans, except Medicaid -Tricare is not considered a group health plan Unbundling Fraudulent practice of breaking down services currently bundled together in one CPT code into individual codes for the purpose of higher reimbursement. Upcoding Process of assigning an inaccurate billing code for a medical procedure or treatment to increase reimbursement, considered to be a fraudulent billing practice. Verification of Physician Be sure to verify that the physician who will be treating the patient is on the panel of providers for the patient's insurance. This is especially important when a patient comes in who is unassigned (does not have a primary care physician) and will be accepted by the physician on call. Veterans Administration (VA) Largest integrated healthcare system in America serving veterans who served in the active military for at least 24 continuous months and were discharged or released under any condition other than dishonorable (some exceptions exist). Veterans Choice Program Program where the VA enrolled member is authorized to receive care from community-based providers. Care is authorized when their local VA health care facility is unable to provide services due to: -Medical care at the VA is not available for at least 30 days or extended wait times for appointments -Lack of available specialists in the area -Patient lives more than 40 miles from a VA medical care facility -When traveling creates excessive travel burdens Office of the Inspector General (OIG) Is a division of the US Department of Health and Human Services (HHS). It is the OIG's responsibility to protect the integrity of HHS programs and the well-being of beneficiaries by detecting and preventing fraud, waste and abuse; improve program efficiency and effectiveness; and holding accountable those who do not meet program requirements or violate the federal healthcare law. The two major programs under HHS are Medicare and Medicaid. The OIG is also responsible for educating the public about fraudulent schemes so they can protect themselves and know how to report suspicious activities. Some of the more common fraud laws include: The Stark Law, the Anti-Kickback Statute and the False Claims Act. Purpose of a Compliance Program The OIG states that "compliance is a dynamic process that helps to ensure that hospitals and other healthcare providers are better able to fulfill their commitment to ethical behavior, as well as meet the changes and challenges being imposed upon them by Congress and private insurers." With the establishment of a voluntary compliance program and a designated hospital compliance officer, hospitals will be able improve the quality of patient care, substantially reduce fraud, waste and abuse, and reduce the cost of healthcare to federal, state and private health insurers. Elements of a Compliance Program include: I. Establish compliance standards, procedures and policies II. Assign oversight responsibility for compliance to an individual high in the organization's structure (i.e., dedicated compliance officer and a compliance committee) III. Screening and evaluation of employees, physicians, vendors IV. Communication, education and training on compliance issues V. Monitoring, auditing and the establishment of internal reporting systems (e.g., anonymous hotlines, email, etc.) VI. Discipline for non-compliance VII. Respond appropriately and immediately to detected offenses What components of the establishment of compliance standards, procedures and policies have an impact on Patient Access? -Code of conduct -Admission policy -Discharge policy -Patient referrals -Physician agreements -Claim development Name some special areas at high risk for non-compliance: -Billing for items or services not rendered -Providing medically unnecessary services -Upcoding -Outpatient services rendered in connection with inpatient stays -Duplicate billing -Unbundling -Patients' freedom of choice -Credit balances Name some provisions of the The Patient Protection and Affordable Care Act (PPACA): identifiable health information or transmit information electronically -Use and disclosure of PHI is permitted without the individual's permission for Treatment, Payment and Healthcare Operations (TPO) -Limited information can be released for purposes of research and/or public health -Opportunity to agree or object — asking the individual for permission outright; examples of this would be asking the patient if they wish to have their name placed in the facility directory or permission to disclose to individuals' families and friends -Required by law (court orders, regulations) -Victims of abuse, neglect or domestic violence -Public health activities such as the collection of information for controlling diseases, child abuse and neglect reports, exposure to a communicable disease, OSHA, FDA recalls, etc. What is one of the most common HIPAA violations? Opening up a patient's information out of curiosity is a HIPAA violation! Willfully sharing that information with others who are not authorized to have the information is a serious HIPAA violation. PHI Includes: It includes anything that can be considered personally identifiable information (PII), such as: -Patient names -Address -Social Security number -Driver's license numbers -Medical record numbers -Account or encounter numbers -Date of birth -Phone numbers -Insurance policy/ID numbers -Names of relatives -Computer IP addresses -Email addresses -Biometric identifiers, including finger and voice prints -Full-face photographic images NIST National Institute of Standards and Technology What is a HIPAA breach and what must be done following one? A HIPAA breach is the use of or disclosure that compromises the security or privacy of a patient's protected health information (PHI). Following a breach, notification must be provided to the affected individuals. If the breach is over 500 individuals, notice to the media must be provided and a notice to the Secretary of HHS. What are the "Restricted Disclosure" or "HITECH Omnibus"? The first right to restrict PHI disclosure, the "Restricted Disclosure" or "HITECH Omnibus," is important because a patient can request that a healthcare organization not disclose medical information to the patient's insurance company. This is important, and action must be completed in a timely manner and the correct information must be noted in the registration system for this to occur properly. Failure to note a patient's wishes properly, or follow policy, can have extremely negative consequences for both the patient and the healthcare organization. For a healthcare organization to restrict disclosing information about a service, the patient must pay for the service in full out of pocket at the time of service. The restriction does not apply to follow-up visits if they are not paid in for in full out of pocket. What is the second right of PHI? The second right allows a patient to access his or her PHI stored in an EHR. The act states that the individual has the right to a copy of their PHI in electronic format, or a hard copy if the file format requested is not readily available, in a timely manner, normally 30 days. The individual cannot be charged more than a reasonable labor cost for copying the PHI and may not be charged a retrieval fee for locating the data. What can PAFS do to protect PHI? -Interview the patient in private whenever possible -Never discuss patient information in public -Lock your computer when you step away from your desk -Be sure all mobile devices are secure -Have computer screens facing away from public view -Never throw items containing PHI in the trash; use reciprocals dedicated to secure shredding/recycling -Never share your passwords with anyone -Never let someone use your computer while you are signed on -Never look up a patient's information because you can, only when your role dictates the use of patient information PCI DSS Payment Card Industry Data Security Standard (PCI DSS) It is required for any Patient Access professional who handles point-of-service payment collections to follow PCI standards. Any organization that handles branded credit cards, such as Visa, MasterCard, American Express and Discover, is responsible for maintaining the security of all cardholder data. What are some ways that PAFS can protect cardholder information? -Never copy a patient's credit card -Obtain and enter the credit card information in a private place -Only use encrypted devices -Never write down card holder data -Remove all receipts from the printer promptly What is the goal of providing MU Technology? -Improve quality, safety and efficiency, and reduce health disparities -Engage patients and family -Improve care coordination and population and public health -Maintain privacy and security of patient health information The change from Inpatient to OBS is permissible, but only if all of the following conditions are met: -The change in patient status from inpatient to outpatient (observation) is made prior to discharge or release while the member is still a patient of the hospital; -The hospital has not submitted a claim for inpatient admission; -A physician concurs with the utilization review committee's decision; -The physician and utilization review committee's decision is documented in the patient's medical record; and -The medical record should contain orders and notes that indicate why the change was made and that the care was furnished to the member and the participants making this decision, in order to change the status. Medicare Retirement Date Requirements and guidelines: Medicare requires that a beneficiary's retirement dates be recorded in the MSP. This question is used to help determine coverage with group health plans. If the beneficiary is unable to remember their retirement dates, Medicare offers the following guidelines: 1. If the beneficiary retired prior to the Medicare A entitlement date on their card, use the entitlement date. 2. If the beneficiary is dependent under their spouse's group health plan and the spouse retired prior to the beneficiary's Medicare A entitlement date, use the patient's Medicare entitlement date. 3. If the beneficiary worked beyond their Medicare A entitlement date and it has been at least five years since they retired, enter the date of service five years ago. 4. If the retirement date occurred less than five years ago, the hospital must obtain the retirement dates from other resources. What constitutes a recurring visit? How often do you need to verify MSP's? Per CMS regulations, for recurring visits (where one account is created and the patient has several recurring visits for the same service, such as physical therapy, all charges for each visit are entered into the one account), you are required to verify the patient's MSP information every 90 days to ensure the information is current and updated as needed. Pt is 65+ and covered by a GHP through current employment or spouce's current employment. The individual is entitled to medicare. 1st Medicare 2nd COBRA Pt is covered under Workers Comp because of a job-related illness or injury. The individual is entitled to medicare. What is the order of coverage? 1st WC for health care items or services related to job-related illness or injury. 2nd Medicare According to medicare, how much money was lost in 2015 due to fraud, waste, abuse and improper payment? $60 billion Fraud Fraud is the intentional deception or misrepresentation. Abuse Abuse is when healthcare providers unintentionally bill incorrectly, causing unnecessary costs. Examples of fraud and abuse: -Billing for services not rendered -Billing for services multiple times -Knowingly billing for services at a higher complexity -Billing for unnecessary medical services -Misusing codes on a claim, such as upcoding or unbundling -Referring to an entity in which the physician has an ownership or investment Why should an organization seek accreditation? -Helps organize and strengthen patient safety efforts -Enhances community confidence in the quality and safety of care and services -Improves risk management and risk reduction -May reduce liability insurance costs -Provides education to improve business operations -Provides professional advice, counsel and enhances staff education -Provides authority for Medicare certification -Recognized by insurers and other third parties -Aligns healthcare organizations with one of the most respected names in healthcare Medicaid Medicaid is a joint federal and state program that provides health coverage to over 72.5 million Americans.4 Medicaid covers low-income adults, children, pregnant women, elderly adults and individuals with disabilities. Medicaid is the single largest source of health coverage in the United States. The Affordable Care Act gave states the opportunity to expand Medicaid by raising the federal poverty level to 133 percent for children and adults. The majority of states chose this option. What are some of the groups that medicaid covers? -Low-income families -Transitional medical assistance -Qualified pregnant women and children -Individuals receiving SSI -Elderly, blind and disabled -Low-income Medicare beneficiaries States have additional options for coverage, including daycare and taxi rides to and from appointments. They may also choose to cover other groups, such as individuals receiving What are the different tricare plans? -TRICARE Prime -TRICARE Standard -Tricare Extra -Tricare for Life (Medicare wraparound coverage) Who is the principal provider for a Tricare members needs? Military Treatment Facilities (MFTs) are the principal provider for the member's healthcare needs; however, in certain circumstances and with authorization, Tricare members can receive care from civilian hospitals and providers. What are the eligibility requirements for CHAMPVA? -The spouse or child of a veteran who has been rated permanently and totally disabled for a service- connected disability by a VA regional office. -The surviving spouse or child of a veteran who died from a VA-rated, service-connected disability. -The surviving spouse or child of a veteran who was at the time of death rated permanently and totally disabled from a service-connected disability. -The surviving spouse or child of a military member who died in the line of duty, not due to misconduct. -Cannot be eligible for TRICARE. RC1. What is the CMS rule that states that an inpatient stay must cross two midnights to be paid for under Medicare Part A? a. Medicare 72-hour rule b. Medicare Two-midnight rule c. Medicare A Inpatient rule B RC2. Which program is responsible for protecting the integrity of the Hospital and Human Services (HHS) program by detecting and preventing fraud? a. CMS b. HITECH c. OIG C RC3. An effective compliance level has a minimum of how many levels? a. 10 b. 4 c. 7 C RC4. All of the following are part of an effective compliance program except: a. Performing internal audits b. Creating standards of privacy c. Establishing standards, procedures and policies B RC5. EMTALA is a regulation which protects patient from what? a. Not being treating in an emergency due to lack of ability to pay b. Receiving prescription medication at the time of discharge c. Completing all their paperwork A RC6. All of the following are examples of PHI except: a. Patient names b. Computer IP addresses c. Financial assistance brochure C RC7. Meaningful Use is an incentive program to: a. Increase the adoption of qualified electronic health records b. Reduce the cost of care to the patients c. Increase the adoption of qualified paper documentation A RC8. This document is provided to Medicare beneficiaries who are admitted as outpatients receiving observation status that they may have a co-payment and co-insurance. a. MOON b. IMM c. ABN A RC22. Who is the primary payer when the Medicare patient is under the age of 65 and is covered by their spouses BCBS plan through the Federal Government? a. Medicare b. BCBS c. Federal Health Benefit Plan B RC23. What is the time period when a Medicare patient on ESRD's group health plan is the primary payer? a. 3-month coordination period b. COBRA c. 30-month coordination period C RC24. Methodology used to determine income eligibility for Medicaid: a. MAGI b. Dual Eligibility Standards c. FPL 133 A RC25. Name given when a provider screens a patient for temporary Medicaid coverage: a. Temporary CV b. Presumptive Eligibility c. Self-Attestation Coverage Period B Revenue Cycle Revenue cycle is a term for the life of a patient account from creation to resolution. It reflects all the operational components under which a medical facility is reimbursed for services rendered to its patients. Components of revenue cycle include: Scheduling -Pre-registration -Financial pre-requisites -Medical necessity -Arrival -Registration -Wayfinding -Discharge -Q/A-billing pre-requisites -MR coding -Billing -Collections -Bad debt. With respect to access, most reimbursement falls into one of three categories: -Third patient commercial or government-sponsored payers (i.e., Blue Cross, Aetna, Medicare, Medicaid, Tricare) -Other programs such as Worker's Compensation, research grants, clinical trials and studies, service contracts with employers, etc. -Patient payments -In addition, medical facilities provide uncompensated and under-compensated care to patients who qualify for various charity programs and write-offs, plus unpaid balances that eventually go to bad debt. Account flow through the revenue cycle influences several critical elements: -Completeness and accuracy of patient demographic and financial information to ensure correct patient identity and billing. -Completeness and accuracy of clinical information taken at time of scheduling. -Medical necessity determination. -Financial clearance to determine if and how the account will be paid. -Proper completion of forms and signatures for compliance. Access should be aware of and meet these standards regarding 3rd party billing: -Precertification -Medical necessity -Correct diagnosis/CPT codes -Accurate patient/insured name as it appears in payer's records -Accurate policy, group and payer ID numbers *Some payers only allow one chance to fix a claim before it cannot be reimbursed, and claims submitted after the allowed time frame, potentially due to incomplete or inaccurate data, means the claim cannot be reimbursed and is lost revenue for the organization. Patient-owed balances fall into two general categories: -Accounts where patients have no third-party insurance or other coverage and do not qualify for charity or other assistance (aka True Self-Pay) -Balances owed by patients before or after insurance pays Ambulatory Payment Classifications (APCs) For professional services and most outpatient services performed at a hospital, Medicare pays by Ambulatory Payment Classifications (APCs). APCs are tied to CPT (Current Procedural Terminology) codes, which are used for coding procedures. The payment rate established for each APC is calculated based on the national average cost (operating and capital) of the hospitals. CMS 1450 (UB-04): A revised version of the UB-92, a federal directive requiring a hospital to follow specific billing procedures, itemizing all services included and billed for on each invoice. Uniform bill is mandated by the Centers for Medicare and Medicaid Services (CMS) for use by hospitals, skilled nursing facilities, home health agencies, community mental health facilities, etc. "Form locator" is the name of the data fields on each of the uniform bills (i.e., UB-04). The UB-04 has 81 numerically sequenced form locators, while the 1500 has 33 form locators. Sometimes the form locators are referred to as boxes, such as Box 1, Box 4. Co-pay CMS 1500: CMS 1500 is used by physicians and other clinicians. It is a fixed amount that the beneficiary pays for healthcare services, regardless of the actual charge; the amount is designated by an insurer as the patient's responsibility. Most health maintenance organizations (HMOs) and preferred provider organizations (PPOs) have co-pays for emergency and urgent care visits; many waive the co-pay if the patient is admitted. Some insurance companies call this "cost-share." In accordance with Section 501(r) regulations through the Affordable Care Act, a hospital must: Establish a written financial assistance policy and make it available to patients. A financial counselor can help determine what financial assistance is available to a patient and apply for financial help. Out-of-Pocket Maximum The total payments toward eligible expenses that a covered person funds for him/herself and/or dependents. These expenses may include deductibles, copays and coinsurance as defined by the contract. Once this limit is reached, benefits will increase to 100 percent for health services received during the rest of that calendar or policy year. Deductibles may or may not be included in out-of-pocket limits. Coinsurance The percentage amount that is payable, per policy provisions, toward medical costs after the deductible has been met. For example, a patient's coinsurance amount may be 20 percent, and the insurance company's coinsurance could be 80 percent under a contract. Coordination of benefits (COB) Is a way of determining the order in which benefits are paid, and the amounts that are payable, when a patient is covered by more than one health plan. It is intended to prevent duplication of payments when a patient is covered by multiple group health plans for the same medical service. NAIC National Association of Insurance Commissioners (NAIC) Birthday Rule: According to the birthday rule, the primary plan for a child is the health plan of the parent whose birthday comes first in the calendar year. Remember this is the date, not the year. If both birthdays fall on the same day, then the plan that has been in effect longer is primary. For example: c. Incorrect determination can result in delay in claims reimbursement d. Access staff have a responsibility to determine correct Coordination of Benefits B RCY3. Access's role in revenue cycle is enhanced by staff training in which of the following functions, except: a. Insurance verification b. Financial counseling c. General knowledge of billing requirements d. Patient's diagnosis D RCY4. NAHAM has developed a series of guidelines that identify performance criteria, explain how to measure them and provide Good/Better/Best benchmarks for facilities to measure. These guidelines are called: a. Access Keys b. Map Keys c. Revenue Cycle Keys d. Keys to Success A RCY5. Which is not an example of how Access staff influence the revenue cycle? a. Accurate gathering of patient data helps to ensure timely reimbursement. b. In many facilities Access has taken over responsibility for financial counseling. c. Insurance pre-requisites and high patient deductibles has emphasized focus on front-end processes. d. Kiosks in the Access areas have resulted in shorter patient wait times. D RCY6. All of the following should be reviewed when checking insurance eligibility, except: a. Patient name and date of birth b. Active insurance benefits c. Date became eligible d. When eligibility ends D RCY7. What is a deductible? a. Payment made to pay for your insurance each month b. The amount of the hospital bill not paid by insurance c. The amount the insurance company requires you to pay before insurance pays C RCY8. Successful insurance verification doesn't automatically mean insurance will pay for charges incurred during a visit. a. True b. False A RCY9. A minor child is brought in with insurance from both parents. The mother's birthdate is July 15, 1993. The father's birthdate is February 20, 1995. According to the birthday rule, whose insurance is primary? a. The mother's insurance b. The father's insurance B Information Systems (IS) provides: -Integrated support for all departments within entire health organizations -Identification of patients or records uniquely -Automated functions in the financial, clinical and administrative areas -Improved patient care -Facilitation for reimbursement of services rendered -Easier access to clinical and administrative data -Timesaving automation of tasks that would otherwise require staff time and attention Functions of an IS department in a healthcare organization frequently include all or most of the following: -Supporting installed technologies -Providing safe and secure information network(s) -Partnering with customers to select, implement and integrate systems that address business needs and optimize the use of available funds -Providing appropriate education for the use of hardware and software systems -Integrating data and processes to provide value-added information -Advising, monitoring and ensuring data integrity through analysis and support Scheduled Downtime Occurs on a predictable basis. Procedures for conducting business during these periods are typically well-documented in the Access Department and may involve collecting patient data manually and entering it online in a timely manner when the system comes back up. Scheduled downtime may occur nightly or at other periodic intervals and may affect some departments more than others. It also may occur in association with projects involving system enhancements, upgrades and conversions. The IT department typically notifies departments of these events well in advance. Unscheduled Downtime Is when one or more systems fail to function, often negatively impacting other interfaced systems. The source of the outage may be external, such as a natural disaster, or internal, such as a system crash. Because unscheduled downtime is likely to impact systems throughout the enterprise, Access' role is often defined by a facility-wide plan similar to disaster-related plans. In fact, unscheduled downtime may be regarded as a subset of a facility's overall disaster plan. Roles of IS as it pertains to Patient Access Information Services (a.k.a. Information Technology, or IT) departments support the hardware and software inventory that healthcare facilities use to conduct business. Such support can be provided internally by staff employed by the facility or contracted to vendors who are not facility employees. Hardware Includes keyboards, monitors, central processing units (CPU), servers, printers, cables and cords, credit card machines, kiosks, ten key pad, web cameras, tablets, interpreter system, etc. Software Includes systems programs that make the computers run (operating systems such as Windows and DOS), application programs (registration program, QA, eligibility, address verification, medical necessity) and interfaces. Examples of often confused software/hardware: Hot Spots, function keys and icons are all shortcuts to other pathways, functions or programs. If clicking on an icon does not bring up the anticipated program, it could be the result of a problem with the mouse (hardware) or a program (software). The more Access associates know about the computer systems they use, the more they will be able to troubleshoot on their own or more easily explain the problem to the IT staff so it can be identified and resolved. Common ways data is transmitted include: -Batch processing - many transactions are stored and sent on a prescheduled or demand basis -Interfaces - software takes data from one system and sends it to another, frequently reformatting it to be acceptable to the system Data collected in Access is shared with many other applications, including: -Financial management systems - billing, reimbursement, etc. -Patient care systems - lab, radiology, nursing, etc. -Administrative systems - decision support, quality review, etc. Systems and interfaces that Access staff are familiar with: Access staff are familiar with scheduling, registration and billing systems. Staff has general knowledge of clinical systems to which Access systems pass demographic data and from which they receive clinical data for billing. Medical records systems interface with clinical and registration/financial systems to provide essential billing information. Other "add-on" systems may include contract management, registration wait times, POS collections, quality metrics, QA system, address verification and score cards. Productivity can be: -A quantitative measurement such as registrations completed in a specified amount of time (day, hour, department, per individual) -A qualitative measurement such as accuracy of registrations completed Productivity measures are used to not only monitor output (e.g., number of registrations) but the value of what is produced. Example of quantitative productivity measurements: Total registrations/Hours worked=Registrations per hour Example of qualitative productivity measurements: Total registrations/Errors=Accuracy percentage RM1. One of our most valuable resources is: a. Time b. Money c. Staff d. Vendors A RM2. The largest expense item in the Patient Access budget is: a. Supplies b. Vendors c. Equipment d. Salaries D RM3. Which of the following is a common form used by Patient Access representatives during patient registration: a. HIPAA Notices of Privacy Practices b. Productivity form c. Evaluation form d. Clinical questionnaire A RM4. In Patient Access registration, a standard productivity measurement is the number of: a. Scheduled calls b. Patient registrations c. POS collections d. Quality metrics B RM5. Quantitative measurement in registration is measured by: a. Registrations completed in a specified amount of time b. Scheduled calls completed in a specified amount of time c. Pre-registrations completed in a specified amount of time d. Orders completed in a specified amount of time A What is a good practice of handling walk ins? Be flexible to walk-ins. Take a moment to acknowledge them if you are with someone and let them know an approximate time you will be available to help them. Keep them updated if things change. What is the purpose of scheduling? The purpose of scheduling is to ensure there is staff, resources and equipment to meet the patient's needs and to: -Achieve the maximum patient flow and to minimize patient wait time -Ensure adequate staff is available to perform the service that the patient requires -Ensure that the patient's old chart is available if needed -Make sure that longer intake time is scheduled if the patient is coming for the first time -Obtain insurance information for checking if prior approval is necessary and verify insurance eligibility -Make sure all necessary forms and information are available when the patient arrives -Ensure equipment is available and in working order for patient's needs -Inform the patient if there is prep time needed and ask them to arrive early to ensure patient is ready by the procedure time -Be aware of the department scheduling guidelines in order to ensure you offer patients the most appropriate and convenient options for scheduling their required services -Be sensitive to any scheduling restrictions a patient may have - for example, they are preparing to leave town and need to have their services scheduled sooner rather than later, they have transportation restrictions or difficulties, they want their friend to be able to accompany them for support, etc. While this may make the task of finding an appropriate appointment for a patient a little more challenging, we must maintain the highest possible level of sensitivity to their needs. -Keep in mind the patient's welfare and comfort. If the patient is to have fasting tests, for instance, make an effort to schedule them earlier in the morning to minimize the length of time they need to go without having a meal. What will proper scheduling do for the patient and staff? Proper scheduling will improve patient and staff satisfaction and will be a more effective use of time. What constitutes a compliant order? A compliant order consists of patient name, DOB, diagnosis, procedure, physician name and physician signature. Best practice recommends CPT and ICD-10 codes along with appropriate verbiage. Proper ways of documentation include: Confirm the appropriate patient is selected from the Master Patient Index to ensure accurate information is obtained and for the patient's safety. -Advise patients to bring any required documentation to their appointment (insurance cards, identification, copy of order if provided, physician referrals, copay, deductible, out-of-pocket cost, etc.). -Ensure the services scheduled are the services reflected on the physician order and the order is present and compliant before services are rendered. -A compliant order consists of patient name, DOB, diagnosis, procedure, physician name and physician signature. Best practice recommends CPT and ICD-10 codes along with appropriate verbiage. -If a patient has Medicare, ensure that medical necessity has been checked and that ABN has been provided and signed, if applicable. -Validate insurance eligibility and calculate any out-of-pocket monies to be collected at time of service. -Initiate authorization according to insurance guidelines and contracted payers and document accordingly to prevent future denials. -Identify financial needs and refer to financial counseling those patients that are unable to meet payment terms according to the hospital's financial policy. -Prior to the end of the call, repeat appointment date and time at least once (or request the patient repeat the information back to you) in order to confirm the patient has accurately recorded the appointment information. -Provide any prep instructions as given by the department. -Some hospitals contract with a vendor to provide appointment reminders via text, email or cell to help reduce no-shows. -In many cases, it is useful to note special circumstances on the schedule with the patient's information. For example: "Patient requests a copy of results be faxed to Dr. Smith @ (760) 555-1212"; "Patient is not ambulatory and will need assistance standing"; "Non-English-speaking patient/translator required." Note: your facility may have an alternative method of documenting and sharing this information with the department. Why is it important to document properly? If it is not documented then it did not happen. Document as appropriate for your job description, in the manner chosen by your facility. What are the Do's of documentation? -Check that you have the correct patient -Check that all required information is there -Be concise - ask yourself, "If someone else reads this, will they know what is going on?" -Record time and date of each phone call, who you spoke to, the message and the response -Record follow-up information -Write legibly S4. The part of the process by which patients are referred to a healthcare provider is called _______? a. Onboarding b. Centralized scheduling c. Referral services d. Pre-registration C S5. When might additional clinical documentation be required? a. For certain payers in order to obtain authorization b. If the patient has recently been seen at another facility c. If the patient is a new patient d. None of the above, with electronic medical records, everything should be there A S6. Appointment reminders help reduce ____________? a. No-shows b. Cost c. Volumes d. Customer satisfaction A 2015 criteria for Certified Electronic Health Record Technology (CEHRT) issued by the Office of the National Coordinator for Health IT (ONC) in 2016 as essentials for patient identification and matching: -Patient name -Date of birth -Address(es) -Phone number(s) -Sex/gender Data attributes intended to improve patient identity integrity: -Race -Ethnicity -Place of birth -Father's name -Mother's maiden name Some organizations may also choose to collect the following elements at the point of registration for use in coordination of care, financial clearance and billing follow-up: -Employment status -Service type -Employer information -Service location -Religious preference -Language -Advance directive information -Email address(es) -Next of kin -Insurance information When is the Medical Record Initiation? Upon a patient's first registration at a facility, they will be issued a unique system identification number. This number may be referred to as an enterprise number, medical record number or master patient index number. This number will be used to coordinate the electronic or standard medical record for the patient on the initial and all subsequent visits. A patient's medical records are reviewed on an ongoing basis for completeness of information, and action is taken to improve the quality and timeliness of documentation that affects patient care. Some things to note: -A patient's medical record will be maintained for a minimum of 10 years. -A patient can request a copy of their medical record at any time. -A patient's signature will be required any time a non-referring/ordering physician or practitioner requests a copy of any part of the patient's medical record. -The Health Insurance Portability and Accountability Act of 1996 (HIPAA) gives a patient his/her rights over his/her health information, including the right to get a copy of his/her information, make sure it is correct and know who has seen it. Financial Obligations for Scheduled Services This could also be called "financial pre-determination" or "financial clearance," as it is the method through which the provider identifies actual payment sources and assists the patient in determining expected reimbursement, their out-of-pocket expenses and alternative funding sources. How did the ACA effect OOP costs? Since the ACA was implemented, more patients are faced with higher out-of-pocket cost in the form of deductibles and co-insurance. It is very important that the patient understand their financial obligation or their portion of the estimated bill prior to providing services. The more transparent the healthcare industry can become in their pricing, the more informed the patient can be, thus ensuring improved patient experience. This may also be a good time to collect the copays or ask for a deposit for larger out-of- pocket expenses. Some organizations automate propensity-to-pay solutions to determine a patient's ability to pay, equipping pre-arrival teams with the necessary information to appropriately engage financial counselors or offer charity applications at the earliest time possible. What is demographic information? Demographic information is defined as patient identifying and contact information. Demographic information has both a clinical and financial purpose and must be accurate and complete. Demographic information examples include: -Legal name -Date of birth -Social Security number -Address -Telephone number -Employer -Employer contact information -Emergency contact/next of kin How is demographic information verified? Demographic information is verified by obtaining positive identification of the patient in combination with a verbal interview of the patient or patient representative. Patient Access associates should conduct the interview by asking the patient to validate key data - do not ask by stating what is already listed in the system. What are the steps in determining patient financial responsibility? The first step is contacting the insurance company. This is important to verify eligibility, since they will tell us what services are covered and if the member is currently eligible. Insurance verification can be done in several ways - calling the individual payer directly, accessing a payer (or third party) website, or via integration with the registration system. Once the type of visit is determined, you will be able to gather all necessary information for that particular plan. You must be aware of the type of plan it is (HMO, PPO, etc.). If you do not know, ask the insurance company when you call. Be sure to determine the following: -Insurance eligibility -Authorization requirement -Pre-certification/pre-authorization -Out-of-pocket maximum -Deductible -Co-payment -Co-insurance -Carve out -Lifetime maximum -Exclusions -Verification of physician The next step is to contact the patient. Inform them of their responsibility, as they do not want to be for department locations that may change frequently, this high-tech solution to provide easily updated information may be just what the doctor ordered. What is Patient Access' role in wayfinding? Patient Access plays an important role in assisting in the development of a wayfinding plan, providing information and tools to patients and visitors, and in forwarding feedback from patients and visitors regarding the wayfinding tools. PR1. What are the five data attributes of NAHAM's Best Practice Recommendations? a. Patient name, date of birth, address(es), phone number(s), sex/gender b. Patient name, date of birth, subscriber name, address(es), sex/gender c. Patient name, address(es), phone number(s), insurance, sex/gender d. Sex/gender, patient name, date of birth, next of kin, address(es) A PR2. What law gives the patient his/her right to the use of his/her medical information? a. OIG b. HIPAA c. NAFTA d. ACA B PR3. What steps are involved in the financial clearance process? a. Verify demographics and insurance information are correct b. Verify eligibility, determine prior authorization requirements c. Calculate estimates and out-of-pocket cost d. Qualify patient for discount or charity care, calculate propensity-to-pay score e. All of the above E PR4. What is the first step to verifying eligibility? a. Contacting the insurance company b. Asking the patient c. Copying the insurance card d. Collecting the out-of-pocket due A PR5. What is COB? a. Coordination of benefits b. Couldn't obtain benefits c. Collection of benefits d. Check on balance A PR6. What rule determines which plan will be primary for dependent children when both parents have the child insured under their plan? a. Spouse rule b. Benefit rule c. Birthday rule d. Rule of thumb C PR7. Prior authorization is: a. Certification that the service will be covered b. An action that does not guarantee payment c. A requirement that may vary depending on the contract with the insurance company B PR8. Prior authorization is: a. Certification that the service will be covered b. An action that does not guarantee payment c. A requirement that may vary depending on the contract with the insurance company B PR9. The experience of orienting and choosing a path, self-navigating through the surroundings, going from point-to-point along a predetermined route is an example of ___________? a. Wayfinding b. Centralized scheduling c. GPS d. Patient experience A PR10. What is one name for a comprehensive list of all patients and their key identifiers? a. Master Patient Index (MPI) b. Enterprise Master Person Index (EMPI) c. Corporate Person Index (CPI) d. All of the above D What are some things that Patient Access staff should be aware of when a patient presents with orders? Patients who present to a healthcare organization may have orders for one of several different patient classes such as inpatient, outpatient, observation, emergent, etc. The patient class not only determines the level of care and the urgency of treatment, but it is also a factor in the registration process. Different classes require different forms and different procedures for registration. When can a patient file a grievance? Patients have the right to file a complaint or grievance at any time during the healthcare encounter if they feel an unsatisfactory situation has arisen. The Patient Self-Determination Act (PSDA) of 1990 Affords patients the right to participate in their own healthcare decisions, including the right to receive or refuse treatment. State laws vary on recognized legal documents pertaining to Advanced Directives, Living Wills and Durable Power of Attorney for Healthcare. Some states may limit an individual's rights under certain circumstances, but none may prohibit the patient's right to participate in decision-making. What forms do patients need to receive when coming in for inpatient treatment? -Patient Rights and Responsibilities -Advance Directive -Durable Power of Attorney -HIPAA -Notice of Privacy Practices -Consents -Important Message from Medicare -Medicare Secondary Payer Questionnaire What forms do patients need to receive when coming in for outpatient treatment? -Patient Rights and Responsibilities -Advance Directive -Durable Power of Attorney -HIPAA -Notice of Privacy Practices -Consents -Medicare Secondary Payer Questionnaire -Medicare Outpatient Observation Notice (MOON) What forms do patients need to receive when coming in for observation treatment? -Patient Rights and Responsibilities -Advance Directive -Durable Power of Attorney -HIPAA -Notice of Privacy Practices -Consents -Medicare Secondary Payer -Long-Term Care - Generally provided to the chronically ill or disabled in a nursing facility or rest home. Among the services provided by nursing facilities: 24-hour nursing care, rehabilitative services such as physical and occupational therapy and speech therapy, as well as assistance with activities of daily living. Coverage for nursing facility care is available under both the Medicare and Medicaid programs. Medicare beneficiaries are eligible for up to 100 days of skilled nursing or rehabilitative care. Medicaid coverage is available for those who have exhausted their own resources and require public assistance to help pay for their care. -Respite Care - Short-term care provided at home, in a long-term care facility, at a community-based center, or in a hospital when another setting is not available. Respite care allows families caring for elders or other mentally or physically dependent family members time off in their care-giving responsibilities. This type of care is not reimbursable through Medicare or Medicaid. -Hospice - A non-profit organization dedicated to patients and families facing serious illness or death. Hospice provides a support system to patients and families who choose to share their last days together in the comfort of their home or hospice designated facility. Hospice provides a wide range of services that include: coordination of care with the patient's primary care physician, skilled nursing visits, spiritual counseling and social worker support. The hospice staff are an interdisciplinary team who coordinate an individualized plan of care for each patient that is directed by the primary care physician. Hospice care is a covered service under the Medicare program. -Palliative Care - The medical specialty focused on relief of the pain, symptoms and stress of serious illness. The goal is to improve quality of life. Palliative care is appropriate at any point in an illness and can be provided at the same time as curative treatment. Acute Care Medical attention given to patients with conditions of sudden onset that demand urgent attention or care of limited duration when the patient's health and wellness would deteriorate without treatment. The care is generally short-term rather than long-term or chronic care. ICU Intensive Care Unit. This is the most critical care unit for patients who are unstable or have a high potential of becoming unstable. Many of these patients require invasive monitoring, frequent medications, frequent vital sign recording, and/or ventilators to assist with breathing. Step Down A less critical care unit that is a "step down" from ICU. These patients may still require telemetry. Med/Surg Floor The most basic level of acute care. Typically, does not require frequent vital signs or telemetry. Emergency Services Patients examined on an unscheduled emergent basis for immediate treatment in the emergency facilities of a hospital. Depending on the outcome of the exam and treatment, the patient may be admitted as an observation patient, admitted to the facility as an inpatient or transferred to another facility as deemed necessary by the physician. Ambulatory Services/Same Day Surgery Patient receives surgical treatment and is discharged from the facility within four to six hours of procedure. Ambulatory services can occur in an outpatient hospital department or in a freestanding ambulatory care facility. Long-Term Care Generally provided to the chronically ill or disabled in a nursing facility or rest home. Among the services provided by nursing facilities: 24-hour nursing care, rehabilitative services such as physical and occupational therapy and speech therapy, as well as assistance with activities of daily living. Coverage for nursing facility care is available under both the Medicare and Medicaid programs. Medicare beneficiaries are eligible for up to 100 days of skilled nursing or rehabilitative care. Medicaid coverage is available for those who have exhausted their own resources and require public assistance to help pay for their care. PCI1. What type of service is not generally found on a patient order? a. Inpatient b. Ambulatory surgery c. Observation d. Maternity D PCI2. Patients receive several forms/information notices during the check-in/registration process. Indicate the form they do not receive: a. Patient Bill of Rights b. Notice of Privacy Practices c. Information on Advanced Directives d. Procedural Consent Form D PCI3. What form of identification should be used to verify patient identity? a. Work badge b. Insurance card c. Driver's license d. Social Security card C PCI4. Why is it important to validate type of service when a patient checks in? a. Drives the type of registration flow to be completed b. The registrar can predict the length of stay for the patient c. The Patient Access employee is making sure the physician order is correct A PCI5. The physician order for treatment should include all of the following information, except: a. Type of service b. Level of care c. Reason for visit (diagnosis) d. Patient address D When a patient arrives, what is the responsibility of the greeters and volunteers? -Courteously greet all patients/visitors/family -Assist the patient with getting signed in or checked in. HIPPA privacy changes have impacted the way patients are being checked in. Most hospitals have dispensed with the use of sign-in sheets, as they do not provide privacy. -Record the time of the patient's arrival in the lobby and also later in the registration booth. -Provide the patients with directions to seating, restrooms, etc. Key services provided by the registrar in the booth may include: -Obtaining all accurate demographic, employment, guarantor and insurance data used to help create a chart and set up the account for billing and payments. -Obtaining insurance eligibility responses to determine if insurance will cover the service and also to determine what portion the patient will need to pay. -Obtaining insurance authorizations for the service being provided. -Providing Advance Beneficiary Notice (ABN) in the event a service is deemed not covered by insurance and yet the patient has opted to still have the service; the ABN notice will allow the hospital to bill the patient and get paid for the service. -Providing the patient with payment options and taking their payment. -Performing in the role of Financial Assistance Counselors; this will involve advising the patient of ways to take care of their portion of the hospital charges. -Depending on the hospital's processes, the registrar may also work with the patients who may qualify for Charity Care assistance. What is preregistration and how does it influence fast tracking? Arrival tracking boards or software are often used to identify which patients have arrived for their day of service. Care should be taken to give preference to those patients who have been cooperative with the hospital and completed pre-registration processes. Whenever possible, these patients should be fast- tracked and moved expeditiously onto their test area. Typically, a "completed" pre-registration patient need only to pay their point of service collections (POSC) amounts, sign forms, get an arm band and exit for service. -Accepting responsibility for problem resolution and providing service recovery is a must. -A professional appearance demonstrates competence, so abide by department dress codes. -Navigating through a large facility can be confusing for our patients. Be willing to escort them to their destination. This is especially helpful to the elderly or confused patient. What Are Some Relevant Information or Resources to Be Provided to Patients? -Patients' Bill of Rights should be displayed in the department and provided to all patients who request it. Having copies readily available shows good service. -Financial policies such as prompt pay discounts should be readily available to share with patients. This will demonstrate staff's knowledge regarding financial assistance policies. -Be prepared to offer assistance to patients in the event of a fire or fire drill. The Department of Health and Environmental Control (DHEC) is the regulatory agency overseeing the hospital's compliance with patient safety. -Provide hand sanitizer and face masks to patients needing them. This is important during cold and flu season. -Provide visitation hours, directions to nursing units, service areas, cafeteria, etc., all shows the willingness to make things easier for the patient and family. -Do not try to provide clinical instructions you are not sure of; consult with or go find a clinical practitioner to help explain needed information to the patient. Wayfinding also encompasses service to be helpful to patients such as: -Printed maps with easy-to-follow directions -Detailed, color-coded campus maps for large teaching facilities -Transportation assistance, such as golf cart rides to a location -Wheelchair assistance my need to be given directly or ordered through a central patient transport department -Assistance with luggage for patients staying overnight -Location of nearest parking lots -Parking fees, if appropriate -Patient discharge or drop-off instructions -While most hospitals are now smoke-free, patients will still want to know where they are allowed to smoke by policy. What is patient tracking management and why is it important? Documenting the arrival and departure times allows caregivers to know where a patient is at any point of service during an encounter. What began in a traditional hospital environment as patient tracking and bed cleaning has expanded greatly in the current healthcare environment. Extended services, often involving many physical locations within a healthcare organization, make it more challenging and yet more important to be aware of a patient's current location. Healthcare professionals understand that determining room availability, knowing if a patient has recently been treated, and monitoring a patient's total time in care are important but difficult tasks in a busy healthcare organization. How is patient safety affected when there is overcrowding? Because patient safety is compromised when there is high occupancy and overcrowding, The Joint Commission has included the management of patient tracking and patient flow in their requirements as well. Specifically, JCAHO LD 3.15 states "leaders develop and implement plans to identify and mitigate impediments to efficient patient flow throughout the hospital." The Joint Commission further requires that hospitals "must look at data and use data to make changes, and must have a patient flow committee." Why is transportation important and how does it affect workflow? Hospitals further understand that transportation is an important aspect of patient tracking and patient flow. Whether patients are being taken for a procedure, being transferred to another unit or needing assistance during discharge, efficient transportation is vital to ensure optimal patient tracking and patient flow. Not only is transportation important to patient tracking and patient flow, it is also a point of contact for over 30 percent of inpatients and an opportunity to make a positive impression. Patient flow is often delayed when a wheelchair or stretcher cannot be located. Both patients and staff wait while transporters scramble to find the necessary equipment, creating a patient flow bottleneck that can easily escalate to affect numerous departments, clinical staff and patient wait times. With the use of hospital asset tracking on wheelchairs and stretchers, transporters are able to complete additional daily patient transports and reduce the number of excessive delays associated with patient transport. There are various tools to assist in the process of tracking patient flow and equipment. Some facilities utilize Radio Frequency Identification (RFID) technology to support these processes. RFID is a system that transmits the identity of any object or person (in the form of a unique serial number) wirelessly using radio waves. More healthcare organizations are considering RFID for its potential to improve patient safety and business processes. RFID applications in the healthcare industry are focused on patient safety (identification and medication administration), business flow management and asset/equipment management. PAFE1. What is the number one expectation of patients presenting for care at hospitals? a. Help with finding their way around b. Parking instructions c. Excellent medical care C PAFE2. Patients use the following measures to grade or judge their patient experience, except: a. How helpful staff are b. How long they had to wait c. Knowledgeable staff d. How long it took them to get to the hospital D PAFE3. Is it a good practice to fast-track patients? a. No, we need to interview every patient who comes in the door. b. Yes, but only those patients who are coming in for laboratory work. c. Yes, as long as all information is obtained from the patient. C PAFE4. The following are doorkeeper services that may be provided in Patient Access, except: a. Wayfinding b. Valet parking c. Arrival check-in d. Pet sitting D PAFE5. When should hospitals inform patients of the cost of care and their liability? a. Upon discharge b. In the service area, like the lab c. Prior to receiving services C PAFE6. Should hospitals provide financial assistance to patients? a. Yes, all patients should receive assistance b. Yes, to those patients who meet criteria for assistance c. No patient should receive assistance B What is bed/control management? The process of providing the most appropriate location and level of service is necessary for optimum clinical care delivery to the patient. In many hospitals, this process is referred to as bed control/management. Patient placement includes a request for a bed (inpatient, outpatient, observation, etc.). It involves the collection and documentation of the information necessary to determine that the requirements for the requested level of service are met. Requirements may include: isolation, telemetry needs, special observation etc. When the request has been determined to be appropriate and the requested level for service is available, arrangements are made to assure the patient's timely arrival. This may include transportation arrangements. Patient placement involves a close working relationship with nursing units but requires a central philosophy to maximize the utilization of resources. What is infection control and what are some factors that need to be considered? An important consideration in assigning the appropriate bed is infection control. In acute care hospitals, patients who require contact precautions should be placed in a single patient (private) room when