Crcr stuvia - Study guides, Class notes & Summaries

What is the purpose OIG work plant? - ANSWER-Identify Acceptable compliance programs in various provider setting If a Medicare patient is admitted on Friday, what services fall within the three-day DRG window rule? - ANSWER-Non-diagnostic service provided on Tuesday through Friday What does a modifier allow a provider to do? - ANSWER-Report a specific circumstance that affected a procedure or service without changing the code or its definition IF outpatient diagnostic services are provi...

Stuvia-2748497-crcr-test-review-exam Questions and Answers (2024/2025) (Verified Answers)

Overall aggregate payments made to a hospice are subject to a computed "cap amount" calculated by - ANSWER - The Medicare Administrative Contractor (MAC) at the end of the hospice cap period Which of the following is required for participation in Medicaid - ANSWER - Meet Income and Assets Requirements In choosing a setting for patient financial discussions, organizations should first and foremost - ANSWER - Respect the patients privacy A nightly room charge will be incorrect if the pa...

Through what document does a hospital establish compliance standards? - ANSWER - code of conduct What is the purpose OIG work plant? - ANSWER - Identify Acceptable compliance programs in various provider setting If a Medicare patient is admitted on Friday, what services fall within the three-day DRG window rule? - ANSWER - Non-diagnostic service provided on Tuesday through Friday What does a modifier allow a provider to do? - ANSWER - Report a specific circumstance that affected a proce...

Through what document does a hospital establish compliance standards? - ANSWER-code of conduct What is the purpose OIG work plant? - ANSWER-Identify Acceptable compliance programs in various provider setting If a Medicare patient is admitted on Friday, what services fall within the three-day DRG window rule? - ANSWER-Non-diagnostic service provided on Tuesday through Friday What does a modifier allow a provider to do? - ANSWER-Report a specific circumstance that affected a procedure or ...

The disadvantages of outsourcing include all of the following EXCEPT: a) The impact of customer service or patient relations b) The impact of loss of direct control of accounts receivable services c) Increased costs due to vendor ineffectiveness d) Reduced internal staffing costs and a reliance on outsourced staff - ANSWERSD The Medicare fee-for service appeal process for both beneficiaries and providers includes all of the following levels EXCEPT: a) Medical necessity review by an in...

Important revenue cycle activities in the pre-service stage include; - ANSWER - Obtaining or updating patient and guarantor information In the pre-service stage, the cost of the scheduled service is identified and the patient's health plan and benefits are used to calculate; - ANSWER - The amount the patient may be expected to pay after insurance. Demographic and health plan edit failures are identified and resolved within the Patient Access area. Census activity is processed, Discharges ...

Types of Unscheduled Patients - ANSWER-Urgent (ED) patients, Walk-in OP, Observation patients, and newborns. Resource Coordination - ANSWER-The process of reserving rooms and/or equipment, ordering devices or supplies, and ensuring that professional staff (physicians, nurses, and/or technicians) are available for when a patient arrives. Patient Scheduling Core Concepts - ANSWER-Patient Identification, Requested Service, Scheduling Instructions, Review and Validation, Patient Reminders and ...

What are collection agency fees based on? - ANSWERSA percentage of dollars collected Self-funded benefit plans may choose to coordinate benefits using the gender rule or what other rule? - ANSWERSBirthday In what type of payment methodology is a lump sum or bundled payment negotiated between the payer and some or all providers? - ANSWERSCase rates What customer service improvements might improve the patient accounts department? - ANSWERSHolding staff accountable for customer service dur...

Net Days in AR - ANSWER-Measures how fast receivables are collected. It is a trending indicator of overall A/R performance & revenue cycle efficiency. A/R Aging - ANSWER-Reports divide the AR into 30, 60, 90, and 120 day categories, based on discharge. Credit Balances - Days Outstanding - ANSWER-The dollars in credit balance at the account level divided by the three month daily average of total net patient service revenue. Credit balances should be resolved timely and should be benchmarked...