Overall aggregate payments made to a hospice are subject to a
computed "cap amount" calculated by - ANS ✔The Medicare
Administrative Contractor (MAC) at the end of the hospice cap period
Which of the following is required for participation in Medicaid - ANS
✔Meet Income and Assets Requirements
In choosing a setting for patient financial discussions, organizations
should first and foremost - ANS ✔Respect the patients privacy
A nightly room charge will be incorrect if the patient's - ANS
✔Transfer from ICU (intensive care unit) to the Medical/Surgical
floor is not reflected in the registration system
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The Affordable Care Act legislated the development of Health
Insurance Exchanges, where individuals and small businesses can -
ANS ✔Purchase qualified health benefit plans regardless of insured's
health status
A portion of the accounts receivable inventory which has NOT
qualified for billing includes: - ANS ✔Charitable pledges
What is required for the UB-04/837-I, used by Rural Health Clinics to
generate payment from Medicare? - ANS ✔Revenue codes
This directive was developed to promote and ensure healthcare
quality and value and also to protect consumers and workers in the
healthcare system. This directive is called - ANS ✔Patient bill of rights
The activity which results in the accurate recording of patient bed and
level of care assessment, patient transfer and patient discharge status
on a real-time basis is known as - ANS ✔Case management
Which statement is an EMTALA (Emergency Medical Treatment and
Active Labour Act) violation? - ANS ✔Registration staff may routinely
contact managed are plans for prior authorizations before the patient is
seen by the on-duty physician
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HIPAA had adopted Employer Identification Numbers (EIN) to be used
in standard transactions to identify the employer of an individual
described in a transaction EIN's are
assigned by - ANS ✔The Internal Revenue Service
Checks received through mail, cash received through mail, and lock
box are all examples of - ANS ✔Control points for cash posting
What are some core elements if a board-approved financial assistance
policy? - ANS ✔Eligibility, application process, and non-payment
collection activities
A recurring/series registration is characterized by - ANS ✔The
creation of one registration record for multiple days of service
With the advent of the Affordable Care Act Health Insurance
Marketplaces and the expansion of Medicaid in some states, it is more
important than ever for hospitals to - ANS ✔Assist patients in
understanding their insurance coverage and their financial obligation
The purpose of a financial report is to: - ANS ✔Present financial
information to decision makers
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Patient financial communications best practices produce
communications that are - ANS ✔Consistent, clear and transparent
Medicare has established guidelines called the Local Coverage
Determinations (LCD) and National Coverage Determinations (NCD)
that establish - ANS ✔What services or healthcare items are covered
under Medicare
Any provider that has filed a timely cost report may appeal an adverse
final decision received from the Medicare Administrative Contractor
(MAC). This appeal may be filed with - ANS ✔The Provider
Reimbursement Review Board
Concurrent review and discharge planning - ANS ✔Occurs during
service
Duplicate payments occur: - ANS ✔When providers re-bill claims based
on non-payment from the initial bill submission
An individual enrolled in Medicare who is dissatisfied with the
government's claim determination is entitled to reconsideration of
the decision. This type of appeal is known as - ANS ✔A beneficiary
appeal
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