Internal and external - ANSWER-Patient access service's customers are_____________________.
External Customers - ANSWER-is Vital to ensure a positive
... [Show More] healthcare experience for patients.
Demonstrating compassion - ANSWER-is as significant (important) as competence in assuring that a clean & accurate claim is generated.
All personnel providing services to patients and families - ANSWER-are responsible for knowing, promoting, and assisting patients to exercise their rights.
At anytime - ANSWER-A patient can request a copy of their medical record.
Healthcare entities - ANSWER-are required to have policies in place that limit how much protected information is used, disclosed and requested for certain purposes.
Impact patient care - ANSWER-Errors made in registration can ____________________.
The policyholder - ANSWER-may not be the person whose name appears on the insurance card.
CMS's mission - ANSWER-Includes assuring health security for it's beneficiaries.
Health Insurance Portability and Accountability Act (HIPAA) - ANSWER-Funding to combat fraud and abuse is provided through ______________________.
Result in fines - ANSWER-Failure to comply with completing the MSP Questionnaire can ________________________.
Participants of a Medicare Managed Care Plan - ANSWER-are still Medicare beneficiaries and retain their Medicare rights and protections and receive all regular Medicare covered services.
Commercial Insurance - ANSWER-Blue Cross, Auto Insurance, Workers's Compensation and HMO are all considered ___________________________.
Tricare For Life - ANSWER-will pay all Medicare co-payments and deductibles and cover most of the costs of certain care not covered by Medicare.
CMS - ANSWER-Centers for Medicare and Medicaid Services: The federal agency responsible for maintaining and monitoring the Medicare program, beneficiary services, and Medicaid and state operations.
JCAHO - ANSWER-Joint Commission on Accreditation of Healthcare Organizations
OCR - ANSWER-Office of Civil Rights
PPS - ANSWER-Prospective Payment System
CDR - ANSWER-Clinical Data Repository; a central database that focuses on clinical information
HIPAA - ANSWER-Health Insurance Portability and Accountability Act
COB - ANSWER-coordination of benefits
CWF - ANSWER-Common Working File
MBN - ANSWER-Medicare Beneficiary Notice
DHHS - ANSWER-Department of Health and Human Services
CHIP - ANSWER-Children's Health Insurance Program
PRO - ANSWER-Peer Review Organization
HMO - ANSWER-health maintenance organization
CHAMPVA - ANSWER-Civilian Health and Medical Program of the Veterans Administration; The Civilian Health and Medical Program for the Veterans Administration is an insurance program for the families of veterans.
NAIC - ANSWER-National Association of Insurance Commissioners
A behavior - ANSWER-An action/reaction, The way we conduct ourselves, a role under specific circumstances.
Steps to communication - ANSWER-Encoding, Transmission, and Decoding
Cognitive Characteristics of Adults - ANSWER-At peak of mental abilities; verbal skills; information recall; reasoning.
Patients expect - ANSWER-All healthcare workers & volunteers are compassionate and caring, Staff members are technically competent, Privacy is protected and their individual needs are anticipated & fulfilled, Staff communicates with them using terms & language they understand, and healthcare workers are sensitive to the inconvenience & stress that result from health problems.
10 - ANSWER-Maximum number of years that a patient's medical record will be maintained.
Pre-Registration - ANSWER-Point where a patient's request such as needs for a translator, special equipment, dietary requirements, ect be obtained to enable timely referrals to social services and initiation of discharge planning.
Joint Commission (JCAHO) - ANSWER-This agency's mission is to improve the quality of healthcare for the public by providing accreditation and related services that support performance improvement in healthcare organizations.
3 years - ANSWER-Typical JCAHO accreditation cycle
Administrative systems, Financial management systems, and Patient Care Systems - ANSWER-Data collected in Access is shared with other applications.
Quality improvement is based on - ANSWER-Developing and enforcing standards through surveillance, Measuring and improving outcomes of care, Educating healthcare providers about quality improvement opportunities, Educating beneficiaries to make good health care choices.
CMS - ANSWER-Responsible for implementing federal quality assurance standards in laboratories, nursing homes, hospitals, home health agencies and ambulatory surgical centers.
4 - ANSWER-Parts of Medicare
60 days - ANSWER-Many of days after a Medicare patient's discharge from an inpatient hospital or skilled nursing facility does the benefit period end (providing that the patient has not been readmitted to a facility during that time).
100 days - ANSWER-Days Medicare will pay for in a participating skilled nursing facility when medically necessary.
Medicare Part B - ANSWER-Component of Medicare helps pay for ambulance transportation.
Medicaid - ANSWER-is funded and administered through a State-federal partnership to provide health care coverage for certain low income people.
Medicare Part B - ANSWER-Patient must have to be eligible for Tricare For Life.
Insurance Eligibility, Authorization/Pre certification requirements, and deductible and Co-pay amounts - ANSWER-The verification of benefits process determines _________________________.
NAIC - ANSWER-In an effort to standardize the Coordination of Benefits rules.
HMO's - ANSWER-Insurance plans that strive to control health care cost by requiring members to receive services at designated facilities.
Body Language & Visual Behavoir - ANSWER-Non verbal communication clues.
HIPAA - ANSWER-Patient privacy protections are part of this act.
Staff Empathy - ANSWER-According to a Press-Ganey study, ____________________ has a major impact on a patient's impression of a hospital.
Documented - ANSWER-If it's not _________________________ , it didn't happen
Clinical Prerequisites - ANSWER-Part of this is reviewing service and procedure information with the patient.
Financial Pre - Determination - ANSWER-The method through which the provider identifies actual payment sources and assists the patient in determining expected reimbursement, their out of pocket expenses and alternative funding sources.
Point of Service Collection - ANSWER-Collecting the patient's portion of the bill at the time service is rendered.
EMTALA - ANSWER-Federal law enacted in 1986 by CMS to protect patients against discrimination based on his or her economic status and mandates patients receive a screening exam and stabilizing treatment when seeking emergency medical care of when in active labor.
Secretary of the DHHS - ANSWER-Validates Joint Commission findings.
Office of Civil Rights (OCR) - ANSWER-responsible for the enforcement of HIPAA regulations.
MPI - ANSWER-Will store at least all medical record numbers associated with that entity's patients.
Policyholder/ Subscriber - ANSWER-Person who contracts with the insurance company for health care coverage.
CMS - ANSWER-Created on March 9, 1977 to consolidate into one agency the responsibility for administering Medicare and Medicaid.
Prospective Payment System (PPS) - ANSWER-Legislated in 1983. Reduced the growth rate of Medicare outlays for hospital inpatient services.
DRG - ANSWER-System that pays hospitals a fixed amount per patient based on diagnosis.
APG's or APC's - ANSWER-Outpatient payment system that covers episodes of care for a particular medical diagnosis (excludes Behavior Health) rather than the current system of payments for individual services.
Fiscal Intermediaries - ANSWER-With certain exceptions ______________________ perform bill processing and pay benefits for Medicare Part A.
Carriers - ANSWER-Perform claims processing and benefit payment functions for Medicare Part B.
Important Message from Medicare - ANSWER-Given to all Medicare beneficiaries who are inpatients in participating hospitals.
ABN - ANSWER-Notice that a care provider should ask a Medicare patient to sign if Medicare may not consider the health services to be medically necessary and the patient be billed for the service.
Liability Coverage - ANSWER-Coverage for injuries that are the result of negligence of another party.
Commercial Insurance - ANSWER-Insurance that is not Medicare, Medicaid, Federal, State or County Programs.
Medicare Beneficiary Notice (MBN) - ANSWER-A monthly statement that list claim information and benefit denial letters for Medicare beneficiaries.
CHAMPVA - ANSWER-Health benefit program for the families of disabled veterans and surviving spouse or children of a veteran who dies from a service connected disability.
Coordination of Benefits (COB) - ANSWER-Process of determining the order in which benefits are paid and the amounts that are payable when a patient is covered by more than one health plan.
patient access employees are required - ANSWER-To ask if the patient wishes to "opt out" of the facility directory and should educate the patient on the implication of their choice.
Wayfinding Tools - ANSWER-Should be compliant with ADA (American with Disabilities Act), JCAHO and other governing agencies and regulations.
Electric bed management system - ANSWER-provide timely notification of activity, eliminate delays and manage more efficiently.
Some functions of Patient Access Services - ANSWER-Include permanent identification of the patient (MRN), providing information to the patient (such as the Patients Rights and Responsibilities), and determining special needs of the patient (such as a language barrier).
Respite Care - ANSWER-Is NOT reimbursable through Medicare or Medicaid.
The Provider - ANSWER-Owns the physical health record but the patient has the right to inspect, obtain a copy of, and restrict release of the medical record.
ICD-10-CM - ANSWER-is the accepted diagnostic coding system in the United States.
Medicare Advantage PFFS plans - ANSWER-allow the patient to go to any doctor if the doctor agrees to accept the plan's terms of payment before treatment.
Protection of PHI - ANSWER-is one of the primary aims of HIPAA.
Short term - ANSWER-Patient experiencing acute illness or trauma.
Advance directive - ANSWER-Appointing someone to make medical decisions for you.
Claims being rejected or denied - ANSWER-For many hospitals, inaccurate data entered at registration remain the number one cause.
Patients that have PPO insurance - ANSWER-May choose to go to a non-participating provider, but will pay more out of their pocket for the service.
CDC - ANSWER-Centers for Disease Control and Prevention
IMM - ANSWER-Important Message from Medicare
PHI - ANSWER-Protected Health Information
MRSA - ANSWER-methicillin-resistant staphylococcus aureus
OSHA - ANSWER-Occupational Safety and Health Administration
HIPAA - ANSWER-Health Insurance Portability and Accountability Act
MPI - ANSWER-Master Patient Index
PSDA - ANSWER-Patient Self-Determination Act
EMTALA - ANSWER-Emergency Medical Treatment and Active Labor Act
QIO - ANSWER-Quality Improvement Organization
PPE - ANSWER-Personal Protection Equipment
CDE - ANSWER-Critical Data Element
MSP - ANSWER-Medicare Secondary Payer
LMRP - ANSWER-Local Medical Review Policy
NOPP - ANSWER-Notice of Privacy Practices
Personal Protective Equipment - ANSWER-According to OSHA regulations for workplace health and safety, to protect personnel from exposure, healthcare facilities must provide.
Proper patient Identification - ANSWER-The most important task undertaken by patient access.
Using open-ended questions - ANSWER-Patient access Associates should conduct the interview of the patient or patient representative
respite Care - ANSWER-is short term care provided at home, in a long term care facility, a community based center or a hospital when another setting is not available.
Patient Livability Letter - ANSWER-When calculating patient liability, many healthcare facilities provide a _________________________ to the patient/guarantor to communicate the amount due.
Outpatient Care - ANSWER-Ancillary services, emergency services, and ambulatory services.
Identify the patient - ANSWER-(PHI) is any information that may be used to ___________________.
Standard Precautions includes - ANSWER-Hand hygiene, Personal Protective Equipment, Respiratory Hygiene/Cough Etiguette.
Federal and State Law - ANSWER-Medicaid is available to certain low income individuals and families who fit into an eligibility group.
Wayfinding - ANSWER-Teh use of interactive digital signage (electronic kiosks and flat panel screens) in medical facilities.
Observation Care - ANSWER-Services not reasonable and necessary for the diagnosis or treatment of the patient, but provided for the convenience of the patient or physician, are not considered an appropriate use of this level of care.
CPT - ANSWER-The classification system that identifies procedures and services provided by physicians, hospitals, and ambulatory surgery centers.
Larger wheelchairs, Waiting room chairs, and special beds - ANSWER-To preserve the safety, dignity and comfort of a larger patient or visitor, hospitals must provide.
Incorrect or missing Member ID, Incorrect address, claim submitted to wrong payer - ANSWER-Some of the Critical Data Elements that are commonly entered in error.
MPI - ANSWER-The health system's entire patient population.
Patient Self-Determination Act - ANSWER-Affords patients the right to participate in their own healthcare decisions, including the right to receive or refuse treatment.
Hospice - ANSWER-A non-profit organization dedicated to patients and families facing serious illness or death.
Deductible - ANSWER-A portion of the covered expenses that an insured must pay per benefit period before benefits are paid by the insurance plan.
Medical Record Number - ANSWER-Unique number assigned to each patient that distinguishes the patient and his/her record from all others.
CMS - ANSWER-The federal agency responsible for the administration of Medicare and Medicaid.
"Opting Out" - ANSWER-A patient's right to restrict access to their Protected healthcare Information (PHI) when being treated in healthcare facility.
Revenue Cycle - ANSWER-From the first day a healthcare provider has contact with a patient until the time the patient's bill is settled, the account runs through a predictable series of steps.
RFID (Radio Frequency ID) - ANSWER-A system that transmits the identity of any object or person (in the form of a unique serial number) wirelessly using radio waves.
Important Message from Medicare - ANSWER-Form explaining beneficiary rights under Medicare and detailed instructions on how to file an appeal in the event the beneficiary disagrees with discharge plain or a complaint about care received.
HCPCS - ANSWER-Used to classify items and services provided in the delivery of healthcare.
Managed Care - ANSWER-Any system that manages healthcare delivery with the aim of controlling costs; typically relying on a PCP.
Standard Precautions - ANSWER-A set of infection control practices that healthcare personnel use to reduce transmission of a microorganisms in healthcare settings.
ABN - ANSWER-A notice given to Medicare beneficiaries to convey that Medicare is not likely to provide coverage in a specific case.
Maximum Out of Pocket (OOP) - ANSWER-The most money an insured can be expected to pay for covered expenses per benefit period.
PHI (Protected Healthcare Information) - ANSWER-Any information that may be used to identify the patient.
Primary role of Patient Access - ANSWER-Is to create the basis of the medical record through the capture of specific information prior to the patients encounter.
Active and Passive - ANSWER-Two methods of obtaining customer feedback.
MPI - ANSWER-Is the primary patient tracking link and therefore considered the most important resource in a healthcare facility.
Key performance indicators (KPIs) - ANSWER-help an organizations define and measure progress toward organizational goals.
30% to 50% - ANSWER-of the cost in service organizations is caused by costs related to slow speed or performing rework to satisfy customer needs.
Technical competencies - ANSWER-Include registering, verifying and calculating deposits and are typically learned in an educational environment or on the job.
Benchmarking - ANSWER-is an improvement tool to measure performance.
Gatekeeper - ANSWER-Is a PCP.
Proper identification - ANSWER-begins in patient access.
Largest expense - ANSWER-is Salary, Supplies is the second largest expense.
Two key Performance Indicators - ANSWER-Customer comment cards and customer callback programs. [Show Less]