CRCR Unit 4 (4.1 - 4.9) Post-Service - Financial Care

CRCR Unit 4 (4.1 - 4.9) Post-Service - Financial Care dentify internal controls for cash handling - ANS A. The separation of cash handling procedures whereby the same person who opens and endorses the checks is not responsible for the deposit B. The establishment of internal audits by personnel outside the involved department. C. The routine use of outside auditors to track cash flow D. The routine reconciliation of daily cash against deposits, postings, and write-offs E. The use of multiple levels of authorization for refund checks, write-offs, and disbursements Recognize the general concepts of electronic funds transfer (EFT) - ANS EFT is the electronic transfer of funds from payer to payee through the banking system. It is considered the fastest way to move money because it is possible to transfer funds between banks on the same day. EFT Balancing & Control - EFT simplifies cash balancing & control requirements since the cash is deposited directly into the healthcare provider's bank account. 1. Bank informs healthcare provider of the amount received and issues a deposit. 2. Healthcare provider balances this deposit to the electronic remittance advice (ERA) received. Categorize the different levels of automation used in electronic remittance advice posting - ANS Electronic Remittance Advice (ERA) 835 Data Set - A standardized healthcare claim payment remittance advice known as the 835 format is used to electronically send third-party payment details to healthcare providers. There are 4 levels of automation that can be used. A. Level 1 - electronic receipt of data only. a. Electronic remittance advice is received b. The information is printed c. The printout is then processed the same as a paper remittance advice. d. Advantages include: 1. Saving mail time for remittance 2. Standardized format for data entry B. Level 2 - electronic receipt & electronic data entry: a. With this level, the electronic remittance is received b. Entered into the computer electronically. c. Viewed on a terminal 1. Data entry tasks are eliminated through automated entry of the information, but usually there continues to be a manual matching of remittance information to an individual account and reconciliation of charges submitted to the amount paid. C. Level 3 - electronic receipt, data entry, reconciliation, posting, and closing. a. Electronic remittance advice is received and entered into a computer electronically. b. The remittance data is electronically posted by the patient accounting software, simultaneously updating the patient's account. 1. Standard adjustment codes must be established to automate entries for payments, i.e. contractual allowances and other write-offs. Manual intervention is only needed if there is a disagreement or an error. D. Level 4 - total automation of receipt, data entry, payment posting, and adjustment processing. a, In addition to everything included at level 3, this level links with banking information to allow reconciliation of payments received electronically through a non-bank network, with funds received electronically. 1. Medicare logs and the secondary billing process are automated using the ERA. An electronic explanation of benefits received from the primary health plan is transmitted electronically with the secondary claims. Manual intervention is only required to handle disagreements. Fraud - ANS Cash handling opens the potential for fraudulent activities and therefore it is imperative to implement controls against these attempts. Policies and procedures - Fraud - ANS Policies and procedures should segment responsibilities so that no one individual