ABC Hospital has experienced a 16% increase in new patients over the past 6 months. The hospital is
understaffed in its insurance claim and payment processing department and cannot handle this increase
in work load. It is considering hiring an outsourcing vendor to assist. What are the steps that the hospital
needs to take to establish and ensure a successful vendor relationship? - correct answers**A. Distribute
a RFP to solicit vendor capabilities, evaluate vendor's expertise to provide outsourcing services, visit
vendor locations, perform vendor reference checks, talk with vendor clients, interview vendor
employees to assess experience level.
B. Evaluate vendor's expertise in providing outsourcing services, visit vendor locations, interview vendor
employees to assess expertise level.
What are collection agency fees based on? - correct answersA percentage of dollars collected
Self-funded benefit plans may choose to coordinate benefits using the gender rule or what other rule? -
correct answersBirthday
In what type of payment methodology is a lump sum or bundled payment negotiated between the payer
and some or all providers? - correct answersCase rates
What is an ABN (Advance Beneficiary Notice of Non-coverage) required to do? - correct answersInform a
Medicare beneficiary that Medicare may not pay for the order or service
What type of account adjustment results from the patient's unwillingness to pay for a self-pay balance? -
correct answersBad debt adjustment
,What is the initial hospice benefit? - correct answersTwo 90-day periods and an unlimited number of
subsequent periods
When does a hospital add ambulance charges to the Medicare inpatient claim? - correct answersIf the
patient requires ambulance transportation to a skilled nursing facility
How should a provider resolve a late-charge credit posted after an account is billed? - correct
answersPost a late-charge adjustment to the account
an increase in the dollars aged greater than 90 days from date of service indicate what about accounts -
correct answersThey are not being processed in a timely manner
What is an advantage of a preregistration program? - correct answersIt reduces processing times at the
time of service
What are the two statutory exclusions from hospice coverage? - correct answersMedically unnecessary
services and custodial care
What statement applies to the scheduled outpatient? - correct answersThe services do not involve an
overnight stay
How is a mis-posted contractual allowance resolved? - correct answersComparing the contract
reimbursement rates with the contract on the admittance advice to identify the correct amount
What type of patient status is used to evaluate the patient's need for inpatient care? - correct
answersObservation
Coverage rules for Medicare beneficiaries receiving skilled nursing care require that the beneficiary has
received what? - correct answersMedically necessary inpatient hospital services for at least 3
consecutive days before the skilled nursing care admission
When is the word "SAME" entered on the CMS 1500 billing form in Field 0$? - correct answersWhen the
patient is the insured
,What are non-emergency patients who come for service without prior notification to the provider
called? - correct answersUnscheduled patients
If the insurance verification response reports that a subscriber has a single policy, what is the status of
the subscriber's spouse? - correct answersNeither enrolled not entitled to benefits
Regulation Z of the Consumer Credit Protection Act, also known as the Truth in Lending Act, establishes
what? - correct answersDisclosure rules for consumer credit sales and consumer loans
What is a principal diagnosis? - correct answersPrimary reason for the patient's admission
Collecting patient liability dollars after service leads to what? - correct answersLower accounts
receivable levels
What is the daily out-of-pocket amount for each lifetime reserve day used? - correct answers50% of the
current deductible amount
What service provided to a Medicare beneficiary in a rural health clinic (RHC) is not billable as an RHC
services? - correct answersInpatient care
What code indicates the disposition of the patient at the conclusion of service? - correct answersPatient
discharge status code
What are hospitals required to do for Medicare credit balance accounts? - correct answersThey result in
lost reimbursement and additional cost to collect
When an undue delay of payment results from a dispute between the patient and the third party payer,
who is responsible for payment? - correct answersPatient
Medicare guidelines require that when a test is ordered for a LCD or NCD exists, the information
provided on the order must include: - correct answersA valid CPT or HCPCS code
, With advances in internet security and encryption, revenue-cycle processes are expanding to allow
patients to do what? - correct answersAccess their information and perform functions on-line
What date is required on all CMS 1500 claim forms? - correct answersonset date of current illness
What does scheduling allow provider staff to do - correct answersReview appropriateness of the service
request
What code is used to report the provider's most common semiprivate room rate? - correct
answersCondition code
Regulations and requirements for coding accountable care organizations, which allows providers to
begin creating these organizations, were finalized in: - correct answers2012
What is a primary responsibility of the Recover Audit Contractor? - correct answersTo correctly identify
proper payments for Medicare Part A & B claims
How must providers handle credit balances? - correct answersComply with state statutes concerning
reporting credit balance
Insurance verification results in what? - correct answersThe accurate identification of the patient's
eligibility and benefits
What form is used to bill Medicare for rural health clinics? - correct answersCMS 1500
What activities are completed when a scheduled pre-registered patient arrives for service? - correct
answersRegistering the patient and directing the patient to the service area
In addition to being supported by information found in the patient's chart, a CMS 1500 claim must be
coded using what? - correct answersHCPCS (Healthcare Common Procedure Coding system)
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