Revenue Cycle Management in Healthcare, Exams of Advanced Education

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Important revenue cycle activities in the pre-service stage include; - Obtaining or updating patient and guarantor information In the pre-service stage, the cost of the scheduled service is identified and the patient's health plan and benefits are used to calculate; - The amount the patient may be expected to pay after insurance. Demographic and health plan edit failures are identified and resolved within the Patient Access area. Census activity is processed, Discharges are completed and correctly coded. These activities are considered - Point-of-service revenue cycle activities. HFMA best practices call for patient financial discussions to be reinforced; - With a written statement of the conversation HFMA's patient financial communications best practices specify that patients should be told about the types of services provided and; - Who participates in providing the service, e.g. surgeons, radiologists, etc. The process of evaluating compliance with financial assistance policies involves; - The annual observation, monitoring, and tracking of results for all best practices. The account resolution clock begins when - The first statement is sent to the patient The soft cost of a dissatisfied customer is - The customer passing on information about their negative experience to potential patients or through social media channels The hard cost of a dissatisfied customer is - loss of future revenue When there is a request for service, scheduling staff must first - Confirm the patients key identification information A standardized form informing patients about the conditions that must be agreed to as part of the agreement for the hospital to provide care is called - Conditions of admission Hospitals need which of the following information sets to assess a patients financial status - Demographic, Income, Assets, and Expenses For new patients with no MPI number - A new medical record will be created by the provider

Which option is a government sponsored program that is financed through taxes and general revenue funds - Medicare An increase in the dollars aged greater than 90 days from date of service indicates that accounts are - Not resolved in a timely manner In many states, people covered under the Medicaid program are required to join managed care plans focusing on preventive healthcare - Medicaid Advantage Price is defined as; - The amount actually paid by the health plan and/or the patient for a specific service Patients are contacting hospitals to proactively inquire about costs and fees prior to agreeing to service. The problem for hospitals in providing such information is; - The fact that chargemaster lists the total charge, not net charges that reflect charges after a payer's contractual adjustment

19. Time of the patient portion earlier in the cycle and increases patient satisfaction because; - There is clarity for the patient about what is owed. Because case managers are well positioned to document the clinical reasons for treatment, they are; - Of great assistance to revenue cycle staff working on written appeals for denials
20. The best practice in billing is to generate bills and financial information that is: - Clear, concise, correct, and patient-friendly. Pricing Transparency is defined as readily available information on the price of healthcare services, that together with other information, help define the value of those services and enable consumers to; - Identify, compare, and choose providers that offer the desired level or value. The 501 (r) regulations require not-for-profit providers 501 (c)(3) to do which of the following activities: - Implement a financial assistance program for uninsured and underinsured patients. Net Accounts Receivable is - The amount an entity is reasonably confident of collecting from overall accounts receivable The revenue cycle includes - All of the major processing steps required to process a patient account from the request for service through closing the account Across all care settings, if a patient consents to a financial discussion during a medical encounter to expedite discharge, the HFMA best practice is to - Support that choice, providing that the discussion does not interfere with patient care or disrupt patient flow

Medicare patients are NOT required to produce a physicians order to receive which of these services - Screening mammograms', flu vaccine or pneumonia For routine scenarios, such as patients with insurance coverage or a known ability to pay, financial discussions: - Should take place between the patient or guarantor and properly trained provider representatives. For non-routine scenarios, such as uninsured or underinsured patients: - A financial counselor or supervisor should be involved. The Two Midnight Rule allows hospitals to account for total Hospital time Including - Outpatient time directly preceding the inpatient admission The purpose of the ACA mandated Community Health Needs Assessment is; - To identify significant health needs, prioritize those needs and identify resources to address them. Unless the patient encounter is an emergency, it is more efficient and effective to; - Obtain the required demographic and insurance information before services are rendered. What is likely to occur if credit balances are not identified separately from debit balances in accounts receivable? - The accounts receivable level would be understated.