Chapter 1 Patient Access Services question n answers
graded A+ 2023
Patient Protection and Affordable Care Act (PPACA)
signed into law on March 23, 2010: Pre-existing conditions have been eliminated for
children under age 19 for group health plans. In addition a Pre-Existing Condition
Insurance Plan (PCIP) has been established for people of all ages who have been
locked out of the health insurance market because of a pre-existing condition. For more
information go to www.pcip.gov. All plans (including grandfathered plans) must provide
coverage for adult children until age 26. Non-grandfathered plans must provide
preventive care services with no cost-sharing. All plans (including grandfathered plans)
have eliminated lifetime maximums limits for essential benefits.
Patient Access
first and most critical step within the hospital revenue cycle
Patient Access Common Set of Duties
Selecting the Correct Patient Records from History Files or Accurately Creating a New
Record Verifying and Reporting Insurance Benefits (including limitations and
exclusions) Obtaining Authorization for Services (to be) Provided Estimating the Patient
Expense for Services (to be) Provided Communicating Information Gathered
Appropriately with Patients, Management and Colleagues Collecting Point of Service
Payments or Deposit Securing Commitment for Payment of any Residual Balance
Selecting the Correct Patient Record
Selection of the right record can prevent life-threatening confusion that can occur if the
wrong record (therefore wrong medical history) is selected
Insurance Verification
Focus should be on verification of benefits prior to the rendering of services
Blue Cross
one of the largest non-governmental based sources of reimbursement of hospitals.
operates over 70 different plans and payment arrangements can differ with each local
Blue Cross plan and each hospital
Medicare
Medicare is the largest source of governmental reimbursement for most hospitals. It
primarily provides health care benefits for those patients who are 65 and over.
Medicaid
Medicaid is a federal and state funded program to provide health care for those who are
indigent. Medicaid is normally administered by local state agencies and the hospital's
representative should be aware of Medicaid reimbursement requirements
Workers' Compensation
health insurance to employees who have become ill or are injured as a result of their
employment. Worker's compensation cases are handled differently depending on the
state.
Commercial Insurance and Managed Car
health care benefits to an individual through a for-profit insurance company or
corporation
Benefit verification
graded A+ 2023
Patient Protection and Affordable Care Act (PPACA)
signed into law on March 23, 2010: Pre-existing conditions have been eliminated for
children under age 19 for group health plans. In addition a Pre-Existing Condition
Insurance Plan (PCIP) has been established for people of all ages who have been
locked out of the health insurance market because of a pre-existing condition. For more
information go to www.pcip.gov. All plans (including grandfathered plans) must provide
coverage for adult children until age 26. Non-grandfathered plans must provide
preventive care services with no cost-sharing. All plans (including grandfathered plans)
have eliminated lifetime maximums limits for essential benefits.
Patient Access
first and most critical step within the hospital revenue cycle
Patient Access Common Set of Duties
Selecting the Correct Patient Records from History Files or Accurately Creating a New
Record Verifying and Reporting Insurance Benefits (including limitations and
exclusions) Obtaining Authorization for Services (to be) Provided Estimating the Patient
Expense for Services (to be) Provided Communicating Information Gathered
Appropriately with Patients, Management and Colleagues Collecting Point of Service
Payments or Deposit Securing Commitment for Payment of any Residual Balance
Selecting the Correct Patient Record
Selection of the right record can prevent life-threatening confusion that can occur if the
wrong record (therefore wrong medical history) is selected
Insurance Verification
Focus should be on verification of benefits prior to the rendering of services
Blue Cross
one of the largest non-governmental based sources of reimbursement of hospitals.
operates over 70 different plans and payment arrangements can differ with each local
Blue Cross plan and each hospital
Medicare
Medicare is the largest source of governmental reimbursement for most hospitals. It
primarily provides health care benefits for those patients who are 65 and over.
Medicaid
Medicaid is a federal and state funded program to provide health care for those who are
indigent. Medicaid is normally administered by local state agencies and the hospital's
representative should be aware of Medicaid reimbursement requirements
Workers' Compensation
health insurance to employees who have become ill or are injured as a result of their
employment. Worker's compensation cases are handled differently depending on the
state.
Commercial Insurance and Managed Car
health care benefits to an individual through a for-profit insurance company or
corporation
Benefit verification
