Pre-Service activities
ANSWER : 1. Requested service is screened for med necessity, health
coverage/benefits verified, preauthorization obtained and estimate to patient oop costs
generated within guidelines of NSA and state regulations.
2. Patient notified of financial responsibility includ...
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Pre-Service activities
ANSWER : 1. Requested service is screened for med necessity, health
coverage/benefits verified, preauthorization obtained and estimate to patient oop costs
generated within guidelines of NSA and state regulations.
2. Patient notified of financial responsibility including copayment and health plan
deductibles, eligibility of financial assistance assessed.
3. Patient is scheduled
4. Encounter record is generated and patient and guarantor info is obtained and
updates as part of preregistration.
5. Cost of the scheduled service identified patients health plan benefits are used to
calculate the price of the services to the patient. - includes deductible, coinsurance and
or copayment amounts.
Time of service
ANSWER : Financial account review is completed prior to patient visit.
Patient arrives at service unit where pre-registration record is activated, consents are
signed, copayments and agreed upon amounts are collected.
, Deeagles - Stuvia US
Positive identification is completed, and the patient is given an armband with acct
number.
Scheduled preprocessed patients report to designated express arrival desk located in
centralized area upon arrival.
Unscheduled patients - Time of Service
ANSWER : Comprehensive registration and financial processing is completed at
time of service. Mirroring scheduled patients who is OON with provider furnishing
services during their encounter all federal and state transparency and NSA provisions
are followed to provide consent to patient of their rights
Time of Service steps
ANSWER : Case management and discharge planning are provided.
Orders are entered.
Results are reported.
Charges are generated.
Diagnostic and procedural coding is completed.
ONGOING:
Monitor of charges
Managed care resolution
Patient liabilities resolution, as needed.
Ensure health plan requirements and liability calculations change - vet the changes
against fed/state guidelines. Consent and updated estimates are communicated to
patient and health plan.
Post Service
, Deeagles - Stuvia US
ANSWER : Includes the account activities that occur after the patient is discharged
until the acct reaches zero balance, such as final coding of all services, preparation and
submission of claims, payment processing and balance billing and resolution.
Best practices recognize all three critical segments of the contemporary revenue cycle.
Each segment includes a series of processes which are specifically designed to ensure
accurate data collection, consistent quality, and a high level of patient satisfaction.
Preservice - patient is scheduled and registered for service. Patients service costs are
calculated.
Time of service - Case mgmt and discharge planing services are provided. Consents
are signed.
Post Service - Bill sent electronically to
ANSWER :
Consumer Experience
ANSWER : Each segment of the revenue cycle interacts involving patients. The
key to success is establishing a clear and ever present focus on the patient.
Patient Experience
ANSWER : Patients are demanding info and choices.
Regulations are demanding price transparency. For all known charges - even those not
employed by the provider.
Expect quality - health care and financial care.
Health plans care about quality - HCACPS stars is a measure of satisfaction.
With poor scores - Medicare will be reduced.
Customer Experience
, Deeagles - Stuvia US
ANSWER : Customer service is paramount.
Empowering front line staff to provide patient focused solutions is basic component of
great patient experience.
Best practice communication strategies, scripting and training are good tactics.
Healthcare Dollars and Sense
ANSWER : HFMA revenue cycle initiatives:
Patients Financial communications best practices
Best practice for price transparency
medical account resolution
Financial Discussions
ANSWER : In ED Setting - no patient financial discussions should occur before a
patient is screened and stabilized, in accordance with local regulations governing the
ed.
Emergency med conditions
ANSWER : If medical screening determines that a patient has an emergency med
condition, the financial discussion should occur during the discharge process.
For patients who do not have emergency condition following the medical screening,
discussion may occur during registration at bedside or discharge process.
Non-emergency conditions
ANSWER : Outside ED Setting discussions may take place during registration or
discharge process in a location that does not disrupt patient flow.
If a patient consents to financial discussion during a medical encounter to expedite
discharge, best practice supports that choice.
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