What type of patient status is used to evaluate the patient's need for inpatient care?
Correct Ans-Observation
Coverage rules for Medicare beneficiaries receiving skilled nursing care require that the
beneficiary has received what? Correct Ans-Medically 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 Ans-
When the patient is the insured
What are non-emergency patients who come for service without prior notification to the
provider called? Correct Ans-Unscheduled patients
If the insurance verification response reports that a subscriber has a single policy, what is the
status of the subscriber's spouse? Correct Ans-Neither enrolled not entitled to benefits
Regulation Z of the Consumer Credit Protection Act, also known as the Truth in Lending Act,
establishes what? Correct Ans-Disclosure rules for consumer credit sales and consumer
loans
What is a principal diagnosis? Correct Ans-Primary reason for the patient's admission
, Nurs 8024 pharmacology exam 2 study guide (latest
update) review-writer-avatar 100% Solved
Collecting patient liability dollars after service leads to what? Correct Ans-Lower accounts
receivable levels
What is the daily out-of-pocket amount for each lifetime reserve day used? Correct Ans-
50% 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 Ans-Inpatient care
What code indicates the disposition of the patient at the conclusion of service? Correct
Ans-Patient discharge status code
What are hospitals required to do for Medicare credit balance accounts? Correct Ans-They
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 Ans-Patient
Medicare guidelines require that when a test is ordered for a LCD or NCD exists, the
information provided on the order must include: Correct Ans-A valid CPT or HCPCS code
, Nurs 8024 pharmacology exam 2 study guide (latest
update) review-writer-avatar 100% Solved
With advances in internet security and encryption, revenue-cycle processes are expanding to
allow patients to do what? Correct Ans-Access their information and perform functions
on-line
What are collection agency fees based on? Correct Ans-A percentage of dollars collected
Self-funded benefit plans may choose to coordinate benefits using the gender rule or what
other rule? Correct Ans-Birthday
In what type of payment methodology is a lump sum or bundled payment negotiated
between the payer and some or all providers? Correct Ans-Case rates
What customer service improvements might improve the patient accounts department?
Correct Ans-Holding staff accountable for customer service during performance reviews
What is an ABN (Advance Beneficiary Notice of Non-coverage) required to do? Correct
Ans-Inform 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 Ans-Bad debt adjustment
What is the initial hospice benefit? Correct Ans-Two 90-day periods and an unlimited
number of subsequent periods
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