What is the intended outcome of collaborations made through
an ACO delivery system for a population of patients? - Answer-
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? - Answer-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)? - Answer-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? -
Answer-Pre-service, time-of-service and post-service
What are the steps during pre-service? - Answer-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? -
Answer-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?
- Answer-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? - Answer-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? -
Answer-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? - Answer-Ease of access, improved customer service and
improved quality of care
What are the goals of the engaged patient portion of the rev
cycle? - Answer-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? - Answer-Appropriate payment, effective and efficient
account resolution and decreased cost to collect
Which of the following statements are true of HFMA's Patient
Financial Communications Best Practices? - Answer-The best
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