CHAM Arrival - Revenue Cycle Exam All Possible Questions and Answers with complete solution

Revenue Cycle consists of - Answer-several departments with numerous responsibilities. Department responsibilities and names vary by organization. The key to a strong revenue cycle is a - Answer-clean claim. Patient Access is responsible for over - Answer-60% of the claims fields on a UB04. In 1975, the American Hospital Association brought together all the national payer and provider organizations and developed the - Answer-National Uniform billing committee (NUBC). In an effort to simplify healthcare billing in America and to develop one standard, a nationally accepted billing form was created in 1982. It has been replaced and now the - Answer-Uniform Bill (UB04) is the recognized bill form for hospitals and other institutional healthcare providers. The UB04 document is made up of 81 different data fields, called - Answer-form locators. Each form locator name describes the - Answer-type of information input into the field. Recent changes to the form include an increase in filed size, additional fields being allocated, and labels changed to better explain the purpose of the form locator. Data elements necessary for accurate billing include: - Answer-*Provider and patient information (Form locators 1-41) *Services provided to the patient (Form locators 42-49) *Patient's insurance information (Form Locators 50-65) *Diagnosis, procedure, and physician information (Form Locators 66-81) Required fields are: - Answer-provider name, address and telephone number & pay to name, address[situational] *patient control number *medical/health record number [situational] *Other provider ID [situational] *Insured's name *Patient's relationship to insured *Insured's unique ID (certificate, social security number, HI Claim/ID number) *type of bill *federal tax number *statement covers period (from/through dates) *patient name and address *date of birth *sex *admission date (inpatients) *admission type (inpatients) *patient status *conditions codes [situational] *occurrence code and data[situational] occurrence span code (inpatients) *occurrence span dates (inpatients) *value codes and amounts *revenue code *HCPCS/rate/HIPPS rates codes *service date *units of service *total charges *payer identification (name) *health plan ID *release of information certification indicator *prior payments [situational] *National Provider IDCase Management - Answer-*Insurance group name [situational] *Insurance group number [situational]*treatment authorization code [situational] *document control number [situational] *employer name [situational] *diagnosis and procedure code qualifier *principle diagnosis code *other diagnosis codes*admitting diagnosis *patient's reason for visit [situational] *principal procedure code and date [situational] *other procedure code and date [situational] *attending provider name and identifiers (including NPI) [situational] *operating provider name and identifiers [situational] *remarks [situational] *code-code field [situational Case Management was introduced in the 1980's in order to control costs by - Answer-improving quality and manage use of hospital inpatient resources. There is a renewed interest in case management, as the hospital C Suite is beginning to recognize its unique role as a bridge between the clinical and financial realms of - Answer-healthcare delivery. An interdisciplinary case management team (which may consist of utilization review and discharge planning functions work directly with healthcare providers to ensure - Answer-all admissions and observation stays in the hospital are justified, documentation supports the appropriate level of care and payment for the hospital, roadblock from timely discharge form the facility removed and that condition of care across the continuum improves quality, patient satisfaction avoiding unnecessary readmissions. The case management team also works directly with the finance department to - Answer-streamline the revenue cycle, improve communication with payers and institute operational efficiency and ultimately a more profitable bottom line. Case Management performs five major functions to the revenue cycle team: - Answer-*Obtain preauthorizations and precertification approve from insurance carriers and payers *Reduce unnecessary admission and effectively manage length of stay. Inherently, they manage medical necessity which results in reduction of clinical denials or denied days. *Assist with the discharge process and may assist with CMS regulatory requirements surrounding discharge. i.e. ( IMM, 2 Midnight Rule, Notice Law) *Act as a liaison between providers and the revenue cycle departments (HIM) to ensure accurate, complete documentation for compliant coding and billing processes by providing a careful review of physician documentation (CDI-* Clinical Documentation Improvement) to maximize compliance and reimbursement. Recent CMS regulatory changes require a more proactive collaboration between patient access, case management, utilization review and discharge planning to coordinate - Answer-admission, in house care, discharge and post-acute care services.2 Midnight Rule- On July 1, 2015, CMS released proposed updates to the "Two-Midnight" rule regarding when inpatient admissions are appropriate for payment under - Answer-Medicare Part A.