AAHAM CRCS STACK 3 and 4
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| What are the primary functions and responsibilities of Patient Access? | show 🗑
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| What are the collection control points for a Facility? | show 🗑
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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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| show | MC OP Obervation Notice
No more than 36 hours after observation begins, verbally and in writing.
MC pts and patients in psychiatric and critical access hospitals.
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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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| show | Per CMS, required to retain ABN 5 years from discharge/completion of care (unless the state requires longer) whether the pt accepted/refused care.
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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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| What is an ABN and what must it list? | show 🗑
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| What is the purpose of compliance rules in patient access area? | show 🗑
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| show | -Inpatient (admitted to a bed, expecting hospital care required. also called acute care. Highest level of care.
-Observation - still occupy a bed, but considered OP, monitoring an acute condition that is expected to either get worse or remedy.
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| show | Emergency room - considered OP
Recurring/Series - OP coming regularly like PT or chemo
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| show | Long term care: Chronically ill or disabled, in nursing facility or rest home.
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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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| show | Hospice: no life saving measures, keep pt comfortable and without pain.
Respite: to give a break to non-paid care providers
Home Health - Part time in home nursing care
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| Consent forms: general vs special | show 🗑
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| list and describe the Types of Consent: | show 🗑
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| What does AOB stand for and describe | show 🗑
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| show | The child has:
-fathered or given birth to a child
-no longer requires parental guidance/financial support
-has reached the age of majority
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| Conditions preventing consent | show 🗑
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| show | - Must be clear and concise, legible and well organized
- can never alter, erase, delete, remove or destroy a record
-if correction is needed, authorized personel can draw a single line strike-thru and initial. NO white out.
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| show | - treating or attending physician
- physician extender (PA, NP, etc)
- RN
- A student from an accredited health profession program
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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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| show | Local Coverage Determination: policies made by MACs that specify criteria for svcs and show under what clinical circumstances an item/svc is considered to be reasonable, necessary and appropriate.
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| What is a Definitive Diagnosis? | show 🗑
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| What is a Non-Definitive LCD or NCD? | show 🗑
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| What does MSP stand for and list when this happens: | show 🗑
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| What is the IEQ? What is the CWF? | show 🗑
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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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| What does a provider have to do to terminate a patient relationship? | show 🗑
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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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| How do you determine percentage of occupancy? | show 🗑
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| show | Total number of patient encounters DIVIDED BY number of days in period = avg number of pts seen / day
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larae711
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