What do Case Managers do? -answer Monitor high resource cases to ensure effective
utilization
What is HIM responsible for? -answer all pt medical records: transcribe, coding, release
to biling, answer requests for documentation
What is utilization management responsible for? -answer manage cases: services
correct, on time
What are the three types of utilization review? -answer Prospective, Concurrent,
Retrospective
Where can home health services be offered? -answer Home, Assist Living, neighbors:
just not SNF nor Hospital
To receive -Care payments, what must a SNF have when receiving a pt from a hosp? -
answer A transfer agreement approved by -Care.
Can a home health agency employ another agency to provide services? -answer Yes,
so long as at least one employee of the original agency provides care.
What is the Net Collection Rate? -answer how much cash was collected as a % of
available to collect?
What is the Net Collection Rate benchmark? -answer 95%
What is the benchmark for denials -answer <2% on first submission
Formual for cost to collect -answer total PFS expenses/gross pt care collections
What is the benchmark for cost to collect -answer 2.25%
What % of the UB-04 source of data is from pt access? -answer 40%
What % of the UB-04 source of data is from service depts? -answer 11%
, What % of the UB-04 source of data is from HIM? -answer 20%
What % of the UB-04 source of data is from billing? -answer 20%
What % of the UB-04 source of data is not used? -answer 9%
What % of the CMS 1500 source of data is from pt access? -answer 53%
What % of the CMS 1500 source of data is from service? -answer 14%
What % of the CMS 1500 source of data is from HIM -answer 7%
What % of the CMS 1500 source of data is from billing? -answer 26%
From whom is the UB-04 directed? -answer institutional: hospitals, SNF, hospice
From whom is the CMS 1500? -answer non-institutional: physicians, DME
In the FDCA, what is Title I -answer Truth in Lending Act
What is the Truth in Lending Act -answer 5 points must be triggered (such as interest
will be charged), then must disclose APR, total payments, late payment charges, etc.
What are the penalties for violating the FDCA? -answer creditors can be sued
Who enforces the FDCA for hospitals? -answer FTC
In the FDCA, what is Title III -answer limits garnishments
In the FDCA, what is Title IV -answer Fair Credit Reporting Act
What is the Fair Credit Reporting Act? -answer provides consumer rights in reporting
loans
Are there rules for how a debt collector communicates with debtor? -answer Yes, eg no
profane language, can't contact before 8 AM
Is a newborn a scheduled or unscheduled pt -answer unscheduled
What are the three types of pt access incoming to a HCO? -answer scheduled,
unscheduled, recurring
What is LCD -answer local coverage determinants, in absence of NCD, LCD dtermines
whether -Care will pay for an item or service
The benefits of buying summaries with Stuvia:
Guaranteed quality through customer reviews
Stuvia customers have reviewed more than 700,000 summaries. This how you know that you are buying the best documents.
Quick and easy check-out
You can quickly pay through credit card for the summaries. There is no membership needed.
Focus on what matters
Your fellow students write the study notes themselves, which is why the documents are always reliable and up-to-date. This ensures you quickly get to the core!
Frequently asked questions
What do I get when I buy this document?
You get a PDF, available immediately after your purchase. The purchased document is accessible anytime, anywhere and indefinitely through your profile.
Satisfaction guarantee: how does it work?
Our satisfaction guarantee ensures that you always find a study document that suits you well. You fill out a form, and our customer service team takes care of the rest.
Who am I buying these notes from?
Stuvia is a marketplace, so you are not buying this document from us, but from seller SALVADO. Stuvia facilitates payment to the seller.
Will I be stuck with a subscription?
No, you only buy these notes for £11.90. You're not tied to anything after your purchase.