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CRCS Chapter 3
AAHAM CRCS Certification Chapter 3 - Patient Access / Front Office
| Question | Answer |
|---|---|
| What does ABN stand for? | Advance Beneficiary Notice of Noncoverage |
| What does HINN stand for? | Hospital Issued Notice of Noncoverage |
| What are the primary functions and responsibilities of Patient Access / Front Office? | Scheduling, Preadmission and preregistration, precert and preauth, registration and admission, insurance verification, financial counseling, collection, compliance. |
| What are other names that Patient Access / Front Office is often referred to as? | Admitting, Patient In-take, or Registration |
| (P) What is the primary duty of the front office personnel? | To act as a liaison between the physician and the patient. |
| What does the front need to focus on to have continuous improvement in the patient access process? | customer service to improve initial pt impression, training staff to improve point of service collections, ensure admitting staff is well educated and can answer quest, identify ways to reduce wait times, preregistering pts, making process a positive. |
| What is the first way to maximize facility/ office productivity? | Efficient patient scheduling. |
| How can efficient and effective scheduling help the entire office or hospital? | It can reduce dissatisfaction of physician, administrative, clinical staff, and patients. |
| What can inefficient or ineffective scheduling cause? | Errors in scheduling can create havoc, downtime, overbooking, and dissatisfied patients. |
| What are the three elements that scheduling need to balance? | Patient satisfaction, collection of financial information, demographic information, and insurance information, clinical services |
| What is gathered during the preadmission and preregistration process? | Patient demos (name, address, dob, SSN, etc), financial info, socioeconomic info. |
| Why should complaints decrease with the implementation of a preregistration program? | Financial planning and counseling can d be done in advance, Pts are aware of the admit process, special needs can be ID and accommodated, pt's are prepared and less anxious, admission time is reduced. |
| What other things can be done during preregistration? | preadmission services testing can me accomplished |
| What does Precertification mean? | Is an authorization provided by an insurance company review approving the medical necessity of the services. |
| What is authorization? | It is to treat and authorize for an average length of stay/number of services allowed for the pt's condition are obtained. |
| What happens when appropriate preauthorization is not obtained? | Billing can be delayed while retroactive authorizations/copies of medical rec are obtained. Sometimes, completely denying the claim which increases appeals, time spent by billing staff to rework and lost revenue. |
| What information is helpful to obtain before seeing a patient in the office? | If emergent/non-emergent, new or estb pt, reason for appt, preferred provider, Pt demos, referring provider, PCP, insurance info, third party involvement. Guarantor demos. |
| What is a guarantor? | The person who is responsible for the bill. |
| What is considered a new patient? | A patient who has not received any professional service from that physician or any physician in a group practice within the past three years. |
| What other things need done before the patient arrives in the office for their appointment. | Pulling charts, preparing fee tickets, obtaining referrals for visits, obtaining preauth to see if a patient's insurance will cover a specific procedure. |
| What is a referral? | A piece or paper or electronic version of when a patient's family provider, provides notice to the patient's insurance that the patient is obtaining care to a specific provider. |
| What responsibilities do the registrar have? | Creating the permanent pt med rec, creating pt account for visit, ensuring accuracy of pt account record, collect basic data, verify ins, collect valuables, offer guest services. |
| What tasks must the registar do during and after the appt? | Greeting and checking the pt in, obtaining info for the pt info form, distribute required materials, check the patient out, maintain pt chart, verify ins eligibility, adhere to privacy requirements, |
| What does greeting and checking in patients include? | Verifying patient info again, make copies of current insurance card, collect patient copays. |
| What materials are generally distributed during check-in? | HIPAA privacy notice, Patient Care Partnership brochure / Bill of Rights. (Not on test, but financial policy) |
| What is included in checking the patient out? | Scheduling next appt, collecting financial obligations, completing requisitions for ordered tests, schedule an tests, obtain patient signatures as needed. |
| What is involved in maintaining the patient chart? | Filing of medical records, processing medical record requests, making sure any outside records are scanned into the facility's electronic medical records. |
| What questions should be addressed during insurance verification? | Precert required/obtained, dx covered, 2nd opinion needed? Ded, Coin, OOP Max, Claim submission address/phone, TPA? Auto/WC? Approved # days, Daily room and board allowed? Who is subscriber, Employer?Any limits |
| What tasks does financial counseling include? | Obtain/verify demos, financial info, established ability to pay, collect all info of TPA, Verify benefits, Notify pt of financial obligation, Request pmt in full, establish pmt arrangements, complet all peradmit paperwork. |
| What does the financial counselor do specifically for Facility? | Explain hospital collection policy. Calculate the pt's estimated responsibility based on (ALOS for dx, cost per day, length of stay, procedure being performed, DRG, room charge, TPA) |
| What does DRG mean? | diagnosis-related group |
| What does ALOS stand for? | average length of stay |
| What does POS stand for? | Point of service |
| What is the only cost-effective way to collect small-dollar copayments? | Collecting them at the time of service or POS |
| Is it ok to ask patients to pay their deductible at the time of service if that information is able to be found out before appt time? | Yes |
| What are the 5 facility collection control points? | Preadmission, admission, in-house, at discharge, after discharge. |
| What are the 5 provider practice collection control points? | Preservice, Time of service, in-house, at checkout, post service. |
| True or false: A patient is more likely to pay and estimated portion before or at the time of admission than after insurance adjudicates the claim and pays the provider. | True - Once the urgency is gone, patients are less inclined to pay their portion of the bill. |
| What is a deposit? | The estimated portion of the patient's bill not covered by insurance that is collected before or at time of service. |
| How can deposit be collected. | In one installment or financed over time. Can be collected prior to admission, at admission, or at discharge. |
| What are the advantages of a deposit collection program, when combined with a good preregistration and insurance verification program. | Increased hospital cash collections, reduced amount due at discharge, reduced overall accounts receivable, reduced financial risk and bad debt. |
| What are disadvantages of a deposit collection program? | Possibility of creating a public relations issue between the hospital and the doctor, the patient and the hospital, or the patient and the doctor. |
| What does a compliance plando? | It serves to prevent, identify, and remedy instances of fraud or abuse or other unacceptable conduct. |
| Does patient access have a key role in a compliant billing process? | Yes |
| Why does patient access play a key role in complaint billing? | Because the info entered during registration affects many other areas, and much of the data appears on the claim. Incorrect demographics can lead to fraudulent or abusive bills. |
| What are some documents that patient access department have the responsibility of issuing? | Important Message from Medicare, MOON, Guarantor forms, ABN, HINN, |
| What does MOON stand for? | Medicare Outpatient Observation Notice |
| What does ABN stand for? | Advance Beneficiary Notice of Noncoverage |
| What does HINN stand for? | Hospital Issued Notice of Noncoverage |
| What is the Important Message from Medicare? | It is a message from Medicare that hospitals are required to give all Medicare and Medicare Advantage beneficiaries who are hospital inpatients. Muse be issued within two days of admission and again within two days of discharge. |
| What is the MOON? | It is a standardized notice to inform beneficiaries when they are an outpatient receiving observation services and are not an inpatient of the hospital or critical access hospital. |
| What does NOTICE stand for? | Notice of Observation Treatment and Implications for Care Eligibility |
| When is the MOON required to be given? | When pts are hospitalized for more than 24 hours if they are in observation status. No later than 36 hours after a patient begins to receive observation services, the pt must be informed, both orally and in writing of their observation status. |
| What beneficiaries does the MOON apply to? | Beneficiaries - who do not have Part B coverage, who are admitted as inpatient prior to the required delivery of the MOON, for whom Medicare is either the primary or secondary payer. |
| Who does the MOON apply to? | Applies to Medicare Part A and Medicare Advantage plans, as well as patients in Psychiatric and Critical Access Hospitals. |
| What must be done if the patient refuses to sign the MOON or there is no representative to sign on behalf of the patient.? | Signed by the staff member. Must include the staff member name and title, that they presented the MOON, date and time. They must annotate the Additional Info section of the MOON. |
| What is the purpose of an ABN? | It helps avoid having to write off claims that Medicare deems not "reasonable and necessary." |
| What is an ABN? | It is a document that lets the pt know that the provider believes the service will not be covered by Medicare. It tells the pt the cost and they can decide if they want to go through with the service and be responsible for the service. |
| When does an ABN need to be obtain to be valid? | Before the service |
| What needs to be on the ABN to be valid? | Provider, Pt name and DOS, What the service is, Why provider things it is not covered, price of noncovered item, what the patient wants to do (their options), pt signature and date. |
| Do you need an ABN if Medicare doesn't generally cover the item ? | No. |
| Should every patient get an ABN? | No, only patients that a provider believes a service will not be covered for. |
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