CRCR Exam (Answered) With Complete Verified Solution

CRCR Exam (Answered) With Complete Verified Solution Which of the following statements are true of HFMA's Patient Financial Communications Best Practices? The best practices were developed specifically to help patients understand the cost of services, their individual insurance benefits and their responsibility for balance after insurance if any The patient experience includes all of the following except: The average number of positive mentions received by the health system or practice and the public comments refuting unfriendly posts on social media sites Corporate compliance programs play an important role in protecting the integrity of operations and ensuring compliance with federal and state requirements. The Code of Conduct is: A critical tool to ensure the compliance with the organization's compliance standards and procedures, an essential and integral component of the organization's culture, fosters and environment where concerns and questions may be raised without fear of retaliation or retribution Specific to Medicare fee-for-service patients, which of the following payers have always been liable for payment? Public health service programs, federal grant programs, VA programs, black lung program services and workers comp claims Provider policies and procedures should be in plan to reduce the risk of ethics violations. Examples of ethics violations are: Financial misconduct, overcharging and miscoding claims, theft of property and falsifying records to boost reimbursement, financial misconduct and applying policies in an inconsistent manner Providers are now being reimbursed with a focus on the value of the services provided, rather than volume, which requires collaboration among providers. What is the intended outcome of collaborations made through an ACO delivery system for a population of patients? To eliminate duplicate services, prevent medical errors and ensure appropriateness of care What is the new terminology now employed in the calculation of net patient service revenues? Explicit price concessions and implicit price concessions What are the two KPIs used to monitor performance related to the production and submission of claims to third party payers and patients (self-pay)? Elapsed days from discharge to final bill and elapsed days from final bill to claim/bill submission What are the three traditional steps of the Revenue Cycle? Pre-service, time-of-service and post-service What are the steps during pre-service? 1. The patient is scheduled and pre-registered for service 2. The encounter record is generated and the patient/guarantor information is obtained or updated 3. The requested service is screened for med necessity; insurance is verified and pre-auths obtained 4. The cost is identified and insurance benefits are used to calculate the price of the services to the patient 5. If the service is deemed not med necessary additional processing is done 6. The patient is notified of their financial responsibility including copay/deductible and their eligibility for financial assistance is assessed What happens for scheduled patients at the time of service? 1. Pre-registration record is activated, consents are signed and copays/balances are collected 2. Positive patient identification is completed and an armband is given 3. Alternatively, scheduled patients can report to an express arrival desk What happens for unscheduled patients at the time of service? Comprehensive registration and financial processing is completed at the time-of-service. The process mirrors the work that was completed for scheduled patients prior to service What are the nine steps of time-of-service processing for unscheduled patients? 1. Creation of the registration record 2. Order review to ensure compliance with the rules for what makes a complete order 3. Validation of the health plan and identification of any amount the patient is currently due 4. Completion of med necessity screening, if necessary 5. Review and completion of pre-cert requirements for the order 6. Identification of all charges related to the order and applied insurance benefits to calculate amount due 7. If a balance is due, financial conversation occurs 8. If all is well, patient gets service 9. Charges are entered as services are rendered What is the overview for the three steps of the revenue cycle? 1. Pre-service: the patient is scheduled and registered for service; patient service costs are calculated 2. Time-of-service: case management and discharge planning services are provided; consents are signed 3. Post-service: Bill sent electronically to health plan, patient account is monitored for payment What are the goals of the engaged consumer portion of the rev cycle? Ease of access, improved customer service and improved quality of care What are the goals of the engaged patient portion of the rev cycle? Improve the information and choices for the patient regarding care and financial decisions What are the goals of the satisfied customer portion of the rev cycle? Appropriate payment, effective and efficient account resolution and decreased cost to collect What are the Healthcare Dollar and Sense initiatives? Patient financial communication best practices, best practices for price transparency, medical account resolution. Overall to help make sense of price and value in healthcare What is the best practice for when and where to have patient financial discussions? 1. No discussion before patient is screened and stabilized in the ER 2. If in an emergency medical condition, the conversation occurs in the discharge process 3. In a non-emergency situation, occurs in registration or discharge process in an area that does not disturb others 4. When possible, have financial conversations before services are rendered 5. Have discussions as early as possible What are the typical elements of the best practices of financial discussions? In ED settings, inform patients that quality of care will not be affected by prior balances or insurance status. For elective services, patients are expected to make payments toward past balances. Once patient is stabilized, information can be collected and reviewed for insurance benefits and financial assistance programs. What are the best practices for financial counseling? 1. Discussing patient share: Patient should be provided list of providers that require separate payments and told that estimates may vary from actual cost. Patients should be asked if they want info about payment/financial assistance options 2. Prior balance policies: Clear policies about prior balances that should be available to the public 3. Balance resolution: Policies that work toward amicable resolution with the patient What are the best practices for the provider/patient conversation? Have compassion, use standard language and have written follow-up What is the framework for complying with the best practices for financial conversations? Annual training, training included well rounded material, annual observation/tracking of process, metrics reporting, technology support verification and feedback/response What is price transparency? Pricing information available to patients based on hospital service based on CPT/DRG, the patient's health plan and the patient's benefit plan What is the ACA? (not the affordable care act) The Association of Credit and Collections Professionals International What is the workflow for medical account resolution? 1. Educate patients and follow best practices for communication 2. Make all bills and other communications clear, concise, correct and patient-friendly 3. Establish policies and make sure they are followed internally and by business affiliates 4. Be consistent in key aspects of account resolution- from billing disputes to payment application 5. Coordinate with business affiliates to avoid duplicative patient contacts 6. Exercise good judgement about the best ways to communicate with patients about bills 7. Start the account resolution clock when the first statement is sent to the patient 8. Report to credit bureaus when an account is resolved (if necessary). Track all consumer complaints What does HCAHPS mean? Hospital Consumer Assessment of Healthcare Providers and Systems What is the HCAHPS initiative? To produce a national standard for collecting/reporting patient perspectives that supports valid comparisons among all providers What are the rev cycle team member's roles in patient satisfaction? 1. Implement: implement processed that are patient-centric and efficient (especially in registration, admitting and financial counseling) 2. Educate: Educate patients about insurance coverage and the meaning of copays/deductible/coins 3. Communicate: communicate clear, consistent and timely financial info What is a hard cost? The loss of future revenue What is a soft cost? The customer's passing on information about their negative experience that may influence others not to use a particular provider What departments collaborate closely with rev cycle? IT, clinical services, finance and health plan contracting What is the continuum of care? A way of coordinating and lining healthcare resources to create a seamless movement among care settings How does the physician affect the revenue cycle? Physician writes the order and determines the need for service. The physician's office schedules appointments or provides info to schedule, obtains pre-auths and begins the process of the rev cycle on the right foot What is a SNF? Skilled nursing facility that provides skilled nursing care or rehab services What does a SNF need to be for the continuum of care? Be in a separate location; provide daily skilled services in an inpatient manner that is appropriate for the patient's illness; provide advance directives; have written transfer agreement with one or more hospitals What does a home health agency need to be for the continuum of care? Must furnish at least one of the qualifying services, provide supervision/policies by a physician or RN, maintain clinical records, are licensed by state/local law, follow additional conditions What are the two additional conditions for Medicare coverage of a home health service? 1. A physician must certify a patient is confined to his/her home. This means leaving the home would be a considerable/taxing effort 2. A patient's place of residence may be their own dwelling, a relative's home, a home for the aged or some other type of institution What is the durable medical equipment for continuum of care? Medical equipment prescribed by a doctor that must be durable and primarily for medical purposes What is a hospice home? A home to terminally ill patients What is the Medicare coverage for hospice care? Two 90 day coverage periods and an unlimited number of periods that are up to 60 days What is an assisted living facility? an institution which provides the elderly with supervision or assistance with activities of daily living, coordination of services with outside healthcare providers, and overall monitoring of health, safety, and well-being Who covers the cost of assisted living? Some health plans but mostly individuals and families pay. Medicare does not pay What are the sixteen elements of the corporate compliance program? 1. Self-reporting: self-reporting may preempt or mitigate the need for sanctions 2. Corporate culture: a culture that encourages identification of potential or actual violations 3. Full support of the highest level of personnel and making a compliance officer 4. oversight of personnel by high-level personnel 5. Written procedures that promote the organizations' commitment to compliance 6. Development and implementation of a regular, comprehensive training and education program 7. Maintenance of a hotline or other mechanism to receive anonymous communications regarding potential compliance issues 8. Employment of excluded individuals 9. Reasonable methods to achieve compliance with standards 10. Established compliance standards and procedures 11. Written communication standards and procedures 12. An effective plan to communicate the above written standards and procedures internally to employees and agents 13. Discretionary authority vested in persons unlikely to engage in criminal conduct 14. Mechanisms for monitoring compliance, including independent evaluations 15. Appropriate and consistent disciplinary measures for employees violating procedures/ethics 16. Implementation of an audit plan What is an organization's code of conduct? The core activities to which the organization is committed What are the Office of inspector general's responsibilities? Identifying opportunities to improve program economy, efficiency and effectiveness Holding accountable those who do not meet program requirements or who violate federal laws What does the BAA stand for? Business Associate Agreements What is the 2020 OIG Work Plan Tasks? Medicare payments outside the hospice benefit Denials and Appeals in Medicare Part C and D