AAHAM CRCS STACK 3 and 4
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| show | Scheduling
Pre admission/pre registration
Pre-cert/pre-auth
Reg/admission
Ins Verification
Financial Counseling
Collection
Compliance
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| show | Pre-admission
Admission
In-house
At discharge
After Discharge
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| What are the collection control points for a provider practice? | show 🗑
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| What does MOON stand for and describe | show 🗑
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| When is the MOON expected to be given and to whom does it apply? | show 🗑
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| What are the rules for the Important Message from Medicare? | show 🗑
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| What are the functions of Case Management (F)? | show 🗑
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| What does HINN stand for and describe | show 🗑
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| What are the rules for ABN retention? | show 🗑
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| show | Initiation: Start of trmt, signed prior to svcs
Reduction: frequency/duration of care is decreased - only if pt wants to continue frequency knowing it won't be covered.
Termination: If beneficiary elects to continue trmt that MC deems no longer nec.
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| show | Advance Beneficiary Notice of Noncoverage
must be signed preservice if provider thinks MC might not deem it medically necessary.
Must have description of svc, estimated cost and reason it's expected to be non-covered.
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| What is the purpose of compliance rules in patient access area? | show 🗑
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| Explain Inpatient and Observation levels of care: | show 🗑
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| show | Emergency room - considered OP
Recurring/Series - OP coming regularly like PT or chemo
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| Explain what LTC (level of care) stands for and describe: | show 🗑
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| show | Office: Practioner's place of business.
OP: Urgent care offices, IV therapy, pain management, wound care, Substance abuse rehab.
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| show | Skilled Nursing Facility
Must be inpatient in hospital 3 days (not including day of discharge)
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| Explain Hospice, Respite and home health levels of care: | show 🗑
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| Consent forms: general vs special | show 🗑
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| show | Actual/expressed - written or oral
Informed consent: required unless and exception is present (incompacity to understand)
Implied in fact: consent by silence, no objection
Implied by law: Pt is unconscious and cannot give consent
Parental/other
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| What does AOB stand for and describe | show 🗑
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| What are the terms for emancipation? | show 🗑
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| show | -Intoxication
-unconsciousness
-declared mentally incompetent by courts
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| What are the rules for handwritten records? | show 🗑
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| Who is authorized to make entries in a patient's medical record? | show 🗑
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| show | - w/ pt written consent
-subpoena from a court and proper notice to the patient or patient's legal rep.
-may be delivered by fax from 1 facility to another w/ auth.
- specific auths are required for dx like hiv, psych, alcohol and drug.
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| show | Can be accepted by:
Physician/physician extender (PA, NP, etc) or RN
MUST CONTAIN:
-date and time of order
Name of ordering physician
name of pt and their status
exact order, verbatim
full name and title of staff member documenting
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| show | National Coverage Determination: med review policies issued by CMS that ID specific DME, svcs, procedures or tech that MC can cover.
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| What does LCD stand for and describe: | show 🗑
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| show | A dx in which a LCD or NCD discusses and lists specific dx codes, ICD (international classification of diseases), procedure codes and sometimes signs & symptoms to support the need for the item/svc.
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| What is a Non-Definitive LCD or NCD? | show 🗑
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| show | MC 2ndary Payer:
- 65+ & works -if employer has 20+ employees
- 65+ w/ spouse cov -employer has more than 100 employees
- has ESRD (for 30 mos, ends 12 mos after dialysys ends. 36 mos after xplant, upon death.
WC, auto, The black lung benefits act.
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| show | Initial Enrollment Questionnaire (for opt initial enrollment in MC)
Common Working File - CMS file w/ pt elegibility & utilization data such as:
-PART A & B ENTITLEMENT & DED INFO
-DOB/DOD
-Benefit periods
-MSP info
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| show | Medicare Secondary Payer Questionaire, form to determine if MC is primary or secondary.
asks about employment, accidents, etc.
Provider must obtain every 90 days for recurring OP accounts.
Must be retained by provider for 10 yrs.
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| show | Provide a 30 day notice in writing with return receipt requested.
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| show | Average length of stay:
Total number of patient days DIVIDED BY number of discharges.
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| What is the midnight census and how to determine: | show 🗑
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| show | Average daily census - average number of inpatients each day for a specific period of time:
Total number of patient days DIVIDED BY number of days in the period = ADC
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| show | Census for determined period of time DIVIDED BY # of licensed beds available = Percentage of Occupancy
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| How to calculate average number of patients seen per day (P)? | show 🗑
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