AAHAM CRCS-1 Exam Questions & Answers

Which collection points are the patient most likely to pay during? - Answer Pre-admission and admission 5 collection control points - Answer -admission sion -house discharge discharge Which percentage should be pre-registered within 24 hours of service date? - Answer 70% to 90% Patient access responsibilities - Answer uling - registration & pre-admission testing (pat) -certification & pre-authorization ient admitting & outpatient registration 5. Insurance verification 6. Financial counseling Deposit - Answer Estimated portion of patient's bill not covered by insurance Advantages of deposit collection program - Answer ase hospital cash collections ed amount due at discharge 3. Reduced overall accounts receivable ed financial risk and bad debt Level of care--Acute inpatient - Answer Acute ill or trauma. Short term Level of care--ancillary - Answer Anything other than regular room and board. Examples Pharmacy Radiology Lab Level of care--observation - Answer Outpatient to monitor patients acute condition MOON - Answer Notice to inform beneficiaries that they are receiving observation and not inpatient. NOTICE act - Answer Notice of observation treatment &a implication for care eligibility act. Must be given to patients in observation to inform them that they are in observation and not inpatient. Within 36 hours Level of care--outpatient - Answer Given to a patient who is not hospitalized. Examples ER Clinic Ambulatory Level of care--long term - Answer Care for chronically ill or disabled in nursing facility or rest home SNF - Answer Skilled nursing facility- must be inpatient for at least 3 day not including discharge day. Hospice - Answer Palliative care for terminal ill Respite - Answer Gives relief to care giver from caring for dependent person Custodial care - Answer Care is primarily for meeting personal needs. Not professional. Not covered by Medicare Home health care - Answer Care provided at patients home. Medicare will only pay is patient is home bound. Office care - Answer Care in physicians place of business Actual or expressed consent - Answer Written or oral patient agrees to treatment Implied consent-in fact - Answer Implied consent by not objecting Implied consent-by law - Answer Patient is unconscious and is taken to ER. Law allows to treat patient Informed consent - Answer Risk and benefits are understood and patient has the right to make informed decision. A person can not give consent if... - Answer icated 2. Unconscious 3. Declared mentally incompetent by courts Emancipation - Answer Process where minor is freed of parental control. If No longer require parental guidance or financial support Father or give birth to a child Reached age of maturity (18 to 21) Medical records - Answer Legal document. If error you much draw single line thru error, initial it, and continue note. DO NOT USE WHITE OUT Authorized to make changes to medical records - Answer 1. Treating or attending physician 2. Pa/ nurse practitioner 3. RN 4. Student under supervision Verbal orders - Answer Can be accepted by physician, pa or nurse practitioner, and RN. Verbal orders have to have..... - Answer 1. Date &a time order was received 2. Name of ordering physician 3. Name of patient and status 4. Exact order, verbatim 5. Full name of designation of staff documenting order ABN - Answer Advance beneficiary notice of non-coverage Form given to avoid w/o of claims considered not "reasonable and necessary" Types of events for ABN - Answer 1. Imitation- occurs at beginning of treatment 2. Reduced- frequency or duration is decreased but patient wants to continue the same care 3. Termination- discontinue to care but patient wants to continue care How long must you keep ABN? - Answer 5 years LCD - Answer Local. Determined by Medicare area contractors NCD - Answer National - determined by CMS Definitive - Answer List of specific diagnosis codes, ICD, and possible signs and symptoms. Non-definitive - Answer Non descriptive. Needs medical records to show medical necessity IEQ - Answer Initial enrollment questionnaire. Sent 3 month priori to being entitled to Medicare. How long must you keep IEQ? - Answer 10 years CWF - Answer Common working file CMS files that contains Medicare patient eligibility and utilization data ALOS - Answer Average Length of Stay Total # of patient days/number of discharges =ALOS Midnight census - Answer Previous midnight census-discharges+admissions +or- status changes=midnight census Percentage of occupancy - Answer Census/#of licensed beds available=percentage of occupancy ADC - Answer Average daily census Total# of patient days/number of days=ADC Two main governing bodies affecting healthcare - Answer DHHS & CMS DHHS - Answer Department of health and human services. Includes Medicare and Medicaid. CMS - Answer Centers for Medicare and Medicaid Services. Title XVIII - Answer Medicare Title XIX - Answer Medicaid QIO - Answer Quality improvement organization. Review written quality of service complaints then submits to CMS Right to personal privacy and confidentiality - Answer Requires all service areas to keep patients info Right to participate in treatment decisions - Answer Ensure patients understand their rights to participate in their healthcare Living will - Answer Specific what treatments a patient does or doesn't wish to receive, difficult about future care are made while the patient is alert Power of Attorney or durable power of attorney - Answer Designates someone else to make decisions on patients behalf