CRCR 3 - TIME OF SERVICE FINANCIAL CARE QUESTIONS AND ANSWERS |
GRADED A+ | GUARANTEED PASS!!
1. EMTALA prohibits inquiries about health plan or liability payer
information if the inquiry will delay examination or treatment.
What other requirements apply to the Emergency Department registration
work?
ANS: All of the above.
2. Typical activities which must be performed when an unscheduled patient
arrives for service include:
ANS: Identification of patient in the MPI or initiation of a new MPI record, insurance
verification of eligibility and benefits, managed care screening, medical necessity
screening, price estimation and financial counseling to achieve the appropriate
account resolution.
3. Case managers are involved from admission with the discharge planning
process.
The purpose of discharge planning is:
ANS: To estimate how long the patient will be in the hospital, identify the expected
outcome of the hospitalization and initiate any special requirements for services at
or after the time of discharge.
4. The chargemaster is basically a list of services, procedures, room
accommodations, supplies, drugs, tests, etc. typically associated with
the billing for services rendered to patients.
Challenges typically associated with the chargemaster include:
1/5
, ANS: Omission of charges, obsolete or invalid codes, and the omission of
required modifiers.
5. Ultimately, the services provided in the healthcare system are reduced to
standard codes. The primary types of coding systems currently used in
healthcare are:
ANS: ICD-10-CM/ICD-10-PCS; CPT/HCPCS codes
6. There are four code sets that provide health plans with additional
information as they process claims.
Those code sets are:
ANS: Condition codes, occurrence codes, occurrence span codes and value
codes.
7. Each type of service has unique billing rules which come into play
during the provision of service.
For the skilled nursing facility, care is covered if which of the following
factors are present:
ANS: The patient required skilled services on a daily basis and those services can
only be provided on an inpatient basis in a SNF.
8. DRGs are a system of classifying inpatients on the basis of diagnoses,
procedures, and co-morbidities for purposes of payment to hospitals.
Each DRG includes:
ANS: A relative weight which is multiplied by the established base payment rate to
calculate the reimbursement for a specific DRG. For exceptionally costly cases
over a set dollar amount, an outlier payment is added to the calculated payment.
9. PPO networks represent one form of discounting commonly used by
commercial payers.
The silent PPO represents:
2/5
GRADED A+ | GUARANTEED PASS!!
1. EMTALA prohibits inquiries about health plan or liability payer
information if the inquiry will delay examination or treatment.
What other requirements apply to the Emergency Department registration
work?
ANS: All of the above.
2. Typical activities which must be performed when an unscheduled patient
arrives for service include:
ANS: Identification of patient in the MPI or initiation of a new MPI record, insurance
verification of eligibility and benefits, managed care screening, medical necessity
screening, price estimation and financial counseling to achieve the appropriate
account resolution.
3. Case managers are involved from admission with the discharge planning
process.
The purpose of discharge planning is:
ANS: To estimate how long the patient will be in the hospital, identify the expected
outcome of the hospitalization and initiate any special requirements for services at
or after the time of discharge.
4. The chargemaster is basically a list of services, procedures, room
accommodations, supplies, drugs, tests, etc. typically associated with
the billing for services rendered to patients.
Challenges typically associated with the chargemaster include:
1/5
, ANS: Omission of charges, obsolete or invalid codes, and the omission of
required modifiers.
5. Ultimately, the services provided in the healthcare system are reduced to
standard codes. The primary types of coding systems currently used in
healthcare are:
ANS: ICD-10-CM/ICD-10-PCS; CPT/HCPCS codes
6. There are four code sets that provide health plans with additional
information as they process claims.
Those code sets are:
ANS: Condition codes, occurrence codes, occurrence span codes and value
codes.
7. Each type of service has unique billing rules which come into play
during the provision of service.
For the skilled nursing facility, care is covered if which of the following
factors are present:
ANS: The patient required skilled services on a daily basis and those services can
only be provided on an inpatient basis in a SNF.
8. DRGs are a system of classifying inpatients on the basis of diagnoses,
procedures, and co-morbidities for purposes of payment to hospitals.
Each DRG includes:
ANS: A relative weight which is multiplied by the established base payment rate to
calculate the reimbursement for a specific DRG. For exceptionally costly cases
over a set dollar amount, an outlier payment is added to the calculated payment.
9. PPO networks represent one form of discounting commonly used by
commercial payers.
The silent PPO represents:
2/5
