Revenue Cycle Management in Healthcare, Exams of Nursing

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HFMA

Pre Service, Time of Service, Post Service - correct answer What are the 3 critical segments in the revenue cycle? Pre Service - correct answer Scheduling pre access data collection What is done at time of service (clinical) - correct answer Orders entered, results reported, DX and CPT coding What is done at time of service (administravive) - correct answer final account review pt positively ID preregistration record activated consents signed copayments For unscheduled pt at the time of service - correct answer comprehensive registration and financial processing In the post service what happens to the pt account - correct answer account activities occur after the pat is discharged until the account reaches a zero balance. What happenes during the post service stage? - correct answer Final coding of all services, preparation processing, billing & resolution What should all 3 pre, time and post service do? - correct answer Focus on the pt and financial care,in addition to clinical care. Best practices include - correct answer Communicate, be Consistent, Coordinate, Educate Communication & sharing info w/ pt - correct answer activities support higher levels of pt satisfaction important component of the pt healthcare experience

The Healthcare Dollars & Sense initiative - correct answer Pt financial communications, Price transparency, Medical account resolution Pt financial communications, Price transparency, Medical account resolution - correct answer The Healthcare Dollars & Sense initiative Objective of the HCAHPS initiative? - correct answer To provided a standardized method for evaluating pts perspective on hospital care How many questions does the HCHPS initiative have - correct answer 27 What HCHPS question encompasses all of it - correct answer Would you recommend this hospital to your friends and family HCAHPS - correct answer Hospital Consumer Assessment of Healthcare Providers and Systems What do pts as consumers of healthcare want? - correct answer 2b informed of out of pocket cost, price for service prior 2 care, providers payment expectation and terms Why is the need to satisfy pt's expectations very important - correct answer as expansion to a value- based payment model includes specific question around pr satisfaction What do pt want easy access to - correct answer scheduling process & expect efficient & well trained revenue cycle personnel Revenue staff & leaders can positively impact pt satisfaction & revenue cycle outcomes by focusing on - correct answer Clear communication, Customer service, Quality Physicians, Skilled Nursing Facility, Hospice - correct answer Who are the continuum providers What is continuum of care - correct answer a way of coordinating & linking healthcare resources and avoid duplication, a seamless movement among care settings

What does continuum of care involve - correct answer healthcare professionals in multiple setting at multiple levels working together w/the overall goals of coordinating pt's healthcare What are the OIG work plan tasks to focus through out the year - correct answer Medicare payment made outside of the hospice benefit, Denials and appeals in part C&D, Part B payment for end stage renal disease dialysis, review of home health claims services w/5-10 skilled visits The ongoing OIG may continue in some or all of the following areas as well - correct answer reconciliation of outlier payments, outpatient & inpatient Medicare 2 midnight rule, Medicare cost defective medical devices replacement medical devices, provider based vs free standing clinics, Medicare payment during MS-DRG payment window Every healthcare organization has a compliance program that needs to understand that - correct answer with in the revenue cycle the importance of compliance w/federal and state program requirements. An effective corporate program embodies many - correct answer a program that is transparent, articulated and emphasized that all held personal and organizational responsibility full communication inside and outside the organization What is the purpose of a compliance program - correct answer is to mitigate potential fraud and abuse int eh industry specific key risk areas 1 Element of corporate compliance program - correct answer Self reporting of adverse administrative events and recommendations 2 Element of corporate compliance program - correct answer corporate culture encourages ID of potential actual violations 3 Element of corporate compliance program - correct answer full support highest level of personnel 4 Element of corporate compliance program - correct answer oversight of personnel by high level personnel

5 Element of corporate compliance program - correct answer written procedures ethics policies 6 Element of corporate compliance program - correct answer development regular training education for all 7 Element of corporate compliance program - correct answer Maintenance of hotline 8 Element of corporate compliance program - correct answer exercise due diligence 9 Element of corporate compliance program - correct answer reasonable methods compliance w/monitoring systems & hotlines 10 Element of corporate compliance program - correct answer Established compliance standards and procedures 11 Element of corporate compliance program - correct answer written communication standards and procedures 12 Element of corporate compliance program - correct answer an effective plan communicate the standards & procedures to employees & agents 13 Element of corporate compliance program - correct answer discretionary auth vested in person unlikely to engage in criminal conduct 14 Element of corporate compliance program - correct answer Mechanisms for monitoring compliance including independent evaluations 15 Element of corporate compliance program - correct answer appropriate & consistent disciplinary measure & mechanisms for employees violating procedures/ethics 16 Element of corporate compliance program - correct answer Implementation of a audit plan

16 Element audit plan has the following - correct answer clearly defined goals, personal to do the audit, individuals 2b interviewed, protection by the attorney-client privilege CMS Centers for Medicare&Medicaid Services developed what to promote correct coding methods prevent payment errors? - correct answer The Correct coding initiative CCI 3 day DRG window rule - correct answer certain outpatient services that are provided within 3 days of the admission date by hospitals 2 B billed as part of a inpatient stay ABN purpose - correct answer inform Medicare beneficiary B 4 received specified service that might otherwise B paid for that Medicare certainly or probably will not pay for those services on that particular occasion Medicare will act as secondary - correct answer worked aged, accident, disability, end-stage renal disease ESRD CCI (Correct Coding Initiative) - correct answer correct coding methods on a national basis and prevent payment errors due to improper coding