REVENUE CYCLE MANAGEMENT (PART
1)- FINAL QUESTIONS WITH CORRECT
ANSWERS
RCM - ANSWER-Revenue Cycle Management
RCM plays a role in assuring facilities maintain profitability under the prospective
payment system - ANSWER-~Facilities must constantly examine and implement
methods to either increase reimbursement or decrease costs
~RCM involves decreasing payment delays and lost revenue
RCM is the supervision of all administrative and clinical functions that contribute to the
capture, management, and collection of patient service revenue - ANSWER-
~Components of RCM are similar across various healthcare settings
~Some variation may exist based on institution size (hospital versus physician office),
approach to charge capture (electronic versus manual), and availability of coding
professionals
Historically, RCM used a silo approach with each department (Admissions, HIM,
Business Office and Clinical Departments) responsible for its own functions and
contributions to the revenue cycle - ANSWER-~Reactive in nature, fostered hostility and
division and did not promote communication and collaboration
Currently, most facilities are using a *multidisciplinary or team approach* composed of
representative from all revenue cycle areas - ANSWER-~Promotes better
communication and cooperation, as well as, an understanding of other members' roles
and contributions to the revenue cycle and leads to a proactive approach in addressing
reimbursement issues
~Education is emphasized so participants can be updated on external forces (payer
trends, government and regulatory modifications and organizational strategies)
~Components of the Revenue Cycle:
~Preclaims Submission Activities - Patient Registration & Case Management -
ANSWER-~Collecting the patient's and responsible
parties' information completely and accurately
~Accurately determining the appropriate
financial class
, ~Educating the patient about his or her ultimate
financial responsibility for services rendered
(annual deductible amount, co-pay, non-covered
services, etc.)
~Collecting waivers as applicable (e.g., ABN -
Advanced Beneficiary Notice)
~Verifying data prior to procedures or services
being performed and submitted for payment
~~Surgical precertification
Medicare Advance Written Notices of Noncoverage - - ANSWER-~issued when a
Medicare payment denial is expected in order to transfer financial liability to the
beneficiary
---if facilities do not let the beneficiary know in advance that Medicare will not cover a
service, then the facility must absorb the cost for the service
Noncoverage Types:
Advance Beneficiary Notice (ABN) of Noncoverage - - ANSWER-~issued by
Independent Laboratories, Skilled Nursing Facilities (SNFABN), Home Health Agencies,
Hospice providers, and Religious Nonmedical Health Care Institutions providing Part A
items and services
~SNFABN must be: "Skilled Nursing Facility Advance Beneficiary Notice"
Noncoverage Types:
Hospital-Issued Notice of Noncoverage (HINN) can be issued: - ANSWER-prior to
admission,
at admission,
or at any point during an inpatient stay if the hospital determines the beneficiary's care
is not covered (e.g. medically unnecessary, not delivered in the most appropriate setting
or custodial in nature)
The four HINNs hospitals issue are: - ANSWER-~Preadmission/Admission HINN (HINN
1) - Used prior to an entirely noncovered stay
~Notice of Hospital Requested Review (HRR) (HINN 10): Used for Fee-for-Service
(FFS) and Medicare Advantage Program (Part C) beneficiaries when requesting Quality
1)- FINAL QUESTIONS WITH CORRECT
ANSWERS
RCM - ANSWER-Revenue Cycle Management
RCM plays a role in assuring facilities maintain profitability under the prospective
payment system - ANSWER-~Facilities must constantly examine and implement
methods to either increase reimbursement or decrease costs
~RCM involves decreasing payment delays and lost revenue
RCM is the supervision of all administrative and clinical functions that contribute to the
capture, management, and collection of patient service revenue - ANSWER-
~Components of RCM are similar across various healthcare settings
~Some variation may exist based on institution size (hospital versus physician office),
approach to charge capture (electronic versus manual), and availability of coding
professionals
Historically, RCM used a silo approach with each department (Admissions, HIM,
Business Office and Clinical Departments) responsible for its own functions and
contributions to the revenue cycle - ANSWER-~Reactive in nature, fostered hostility and
division and did not promote communication and collaboration
Currently, most facilities are using a *multidisciplinary or team approach* composed of
representative from all revenue cycle areas - ANSWER-~Promotes better
communication and cooperation, as well as, an understanding of other members' roles
and contributions to the revenue cycle and leads to a proactive approach in addressing
reimbursement issues
~Education is emphasized so participants can be updated on external forces (payer
trends, government and regulatory modifications and organizational strategies)
~Components of the Revenue Cycle:
~Preclaims Submission Activities - Patient Registration & Case Management -
ANSWER-~Collecting the patient's and responsible
parties' information completely and accurately
~Accurately determining the appropriate
financial class
, ~Educating the patient about his or her ultimate
financial responsibility for services rendered
(annual deductible amount, co-pay, non-covered
services, etc.)
~Collecting waivers as applicable (e.g., ABN -
Advanced Beneficiary Notice)
~Verifying data prior to procedures or services
being performed and submitted for payment
~~Surgical precertification
Medicare Advance Written Notices of Noncoverage - - ANSWER-~issued when a
Medicare payment denial is expected in order to transfer financial liability to the
beneficiary
---if facilities do not let the beneficiary know in advance that Medicare will not cover a
service, then the facility must absorb the cost for the service
Noncoverage Types:
Advance Beneficiary Notice (ABN) of Noncoverage - - ANSWER-~issued by
Independent Laboratories, Skilled Nursing Facilities (SNFABN), Home Health Agencies,
Hospice providers, and Religious Nonmedical Health Care Institutions providing Part A
items and services
~SNFABN must be: "Skilled Nursing Facility Advance Beneficiary Notice"
Noncoverage Types:
Hospital-Issued Notice of Noncoverage (HINN) can be issued: - ANSWER-prior to
admission,
at admission,
or at any point during an inpatient stay if the hospital determines the beneficiary's care
is not covered (e.g. medically unnecessary, not delivered in the most appropriate setting
or custodial in nature)
The four HINNs hospitals issue are: - ANSWER-~Preadmission/Admission HINN (HINN
1) - Used prior to an entirely noncovered stay
~Notice of Hospital Requested Review (HRR) (HINN 10): Used for Fee-for-Service
(FFS) and Medicare Advantage Program (Part C) beneficiaries when requesting Quality
