CHAM Arrival - Revenue Cycle questions with correct answers

CHAM Arrival - Revenue Cycle questions with
correct answers
Revenue Cycle consists of CORRECT ANSWER several departments with
numerous responsibilities. Department responsibilities and names vary by
organization.


The key to a strong revenue cycle is a CORRECT ANSWER clean claim.


Patient Access is responsible for over CORRECT ANSWER 60% of the claims
fields on a UB04.


In 1975, the American Hospital Association brought together all the national payer
and provider organizations and developed the CORRECT ANSWER National
Uniform billing committee (NUBC).


In an effort to simplify healthcare billing in America and to develop one standard,
a nationally accepted billing form was created in 1982. It has been replaced and
now the CORRECT ANSWER Uniform Bill (UB04) is the recognized bill form
for hospitals and other institutional healthcare providers.


The UB04 document is made up of 81 different data fields, called CORRECT
ANSWER form locators.


Each form locator name describes the CORRECT ANSWER type of information
input into the field. Recent changes to the form include an increase in filed size,
additional fields being allocated, and labels changed to better explain the purpose
of the form locator.

,Data elements necessary for accurate billing include: CORRECT ANSWER
*Provider and patient information (Form locators 1-41) *Services provided to the
patient (Form locators 42-49) *Patient's insurance information (Form Locators 50-
65) *Diagnosis, procedure, and physician information (Form Locators 66-81)


Required fields are: CORRECT ANSWER provider name, address and telephone
number & pay to name, address[situational] *patient control number
*medical/health record number [situational] *Other provider ID [situational]
*Insured's name *Patient's relationship to insured *Insured's unique ID (certificate,
social security number, HI Claim/ID number) *type of bill *federal tax number
*statement covers period (from/through dates) *patient name and address *date of
birth *sex *admission date (inpatients) *admission type (inpatients) *patient status
*conditions codes [situational] *occurrence code and data[situational] occurrence
span code (inpatients) *occurrence span dates (inpatients) *value codes and
amounts *revenue code *HCPCS/rate/HIPPS rates codes *service date *units of
service *total charges *payer identification (name) *health plan ID *release of
information certification indicator *prior payments [situational] *National Provider
ID


Case Management CORRECT ANSWER *Insurance group name [situational]
*Insurance group number [situational]*treatment authorization code [situational]
*document control number [situational] *employer name [situational] *diagnosis
and procedure code qualifier *principle diagnosis code *other diagnosis
codes*admitting diagnosis *patient's reason for visit [situational] *principal
procedure code and date [situational] *other procedure code and date [situational]
*attending provider name and identifiers (including NPI) [situational] *operating
provider name and identifiers [situational] *remarks [situational] *code-code field
[situational


Case Management was introduced in the 1980's in order to control costs by
CORRECT ANSWER improving quality and manage use of hospital inpatient
resources.

, There is a renewed interest in case management, as the hospital C Suite is
beginning to recognize its unique role as a bridge between the clinical and financial
realms of CORRECT ANSWER healthcare delivery.


An interdisciplinary case management team (which may consist of utilization
review and discharge planning functions work directly with healthcare providers to
ensure CORRECT ANSWER all admissions and observation stays in the hospital
are justified, documentation supports the appropriate level of care and payment for
the hospital, roadblock from timely discharge form the facility removed and that
condition of care across the continuum improves quality, patient satisfaction
avoiding unnecessary readmissions.


The case management team also works directly with the finance department to
CORRECT ANSWER streamline the revenue cycle, improve communication with
payers and institute operational efficiency and ultimately a more profitable bottom
line.


Case Management performs five major functions to the revenue cycle team:
CORRECT ANSWER *Obtain pre-authorizations and precertification approve
from insurance carriers and payers *Reduce unnecessary admission and effectively
manage length of stay. Inherently, they manage medical necessity which results in
reduction of clinical denials or denied days. *Assist with the discharge process and
may assist with CMS regulatory requirements surrounding discharge. i.e. ( IMM, 2
Midnight Rule, Notice Law) *Act as a liaison between providers and the revenue
cycle departments (HIM) to ensure accurate, complete documentation for
compliant coding and billing processes by providing a careful review of physician
documentation (CDI-* Clinical Documentation Improvement) to maximize
compliance and reimbursement.


Recent CMS regulatory changes require a more proactive collaboration between
patient access, case management, utilization review and discharge planning to
coordinate CORRECT ANSWER admission, in house care, discharge and post-
acute care services.