What service provided to a Medicare beneficiary in a rural health clinic (RHC) is not billable as an RHC services? - answer>>.Inpatient care What are collection agency fees based on? - answer>>.A percentage of dollars collected What code indicates the disposition of the patient at the conclusion of service? - answer>>.Patient discharge status code What do the MSP disability rules require? - answer>>.That the patient's spouse's employer must have less than 20 employees in the group health plan what organization originated the concept of insuring prepaid health care services? - answer>>.Blue Cross and blue Shield What are hospitals required to do for Medicare credit balance accounts? - answer>>.They result in lost reimbursement and additional cost to collect When an undue delay of payment results from a dispute between the patient and the third party payer, who is responsible for payment? - answer>>.Patient Self-funded benefit plans may choose to coordinate benefits using the gender rule or what other rule? - answer>>.Birthday In what type of payment methodology is a lump sum or bundled payment negotiated between the payer and some or all providers? - answer>>.Case rates Medicare guidelines require that when a test is ordered for a LCD or NCD exists, the information provided on the order must include: - answer>>.A valid CPT or HCPCS code With advances in internet security and encryption, revenue-cycle processes are expanding to allow patients to do what? - answer>>.Access their information and perform functions on-line What date is required on all CMS 1500 claim forms? - answer>>.onset date of current illness What does scheduling allow provider staff to do - answer>>.Review appropriateness of the service request What code is used to report the provider's most common semiprivate room rate? - answer>>.Condition code Regulations and requirements for coding accountable care organizations, which allows providers to begin creating these organizations, were finalized in: - answer>>.2012 What is a primary responsibility of the Recover Audit Contractor? - answer>>.To correctly identify proper payments for Medicare Part A & B claims How must providers handle credit balances? - answer>>.Comply with state statutes concerning reporting credit balance Insurance verification results in what? - answer>>.The accurate identification of the patient's eligibility and benefits What form is used to bill Medicare for rural health clinics? - answer>>.CMS 1500 What activities are completed when a scheduled pre-registered patient arrives for service? - answer>>.Registering the patient and directing the patient to the service area In addition to being supported by information found in the patient's chart, a CMS 1500 claim must be coded using what? - answer>>.HCPCS (Healthcare Common Procedure Coding system) What results from a denied claim? - answer>>.The provider incurs rework and appeal costs Why does the financial counselor need pricing for services? - answer>>.To calculate the patient's financial responsibility What type of provider bills third-party payers using CMS 1500 form - answer>>.Hospital-based mammography centers How are disputes with nongovernmental payers resolved? - answer>>.Appeal conditions specified in the individual payer's contract The important message from Medicare provides beneficiaries with information concerning what? - answer>>.Right to appeal a discharge decision if the patient disagrees with the services Why do managed care plans have agreements with hospitals, physicians, and other healthcare providers to offer a range of services to plan members? - answer>>.To improve access to quality healthcare If a patient remains an inpatient of an SNF (skilled nursing facility for more than 30 days, what is the SNF permitted to do? - answer>>.Submit interim bills to the Medicare program. 90. MSP (Medicare Secondary Payer) rules allow providers to bill Medicare for liability claims after what happens? - answer>>.120 days passes, but the claim then be withdrawn from the liability carrier What data are required to establish a new MPI entry? - answer>>.The patient's full legal name, date of birth, and sex What should the provider do if both of the patient's insurance plans pay as primary? - answer>>.Determine the correct payer and notify the incorrect payer of the processing error What do EMTALA regulations require on-call physicians to do? - answer>>.Personally appear in the emergency department and attend to the patient within a reasonable time At the end of each shift, what must happen to cash, checks, and credit card transaction documents? - answer>>.They must be balanced What will cause a CMS 1500 claim to be rejected? - answer>>.The provider is billing with a future date of service Under Medicare regulations, which of the following is not included on a valid physician's order for services? - answer>>.The cost of the test how are HCPCS codes and the appropriate modifiers used? - answer>>.To report the level 1, 2, or 3 code that correctly describes the service provided If a Medicare patient is admitted on Friday, what services fall within the three-day DRG window rule? - answer>>.Diagnostic and clinically-related non-diagnostic charges provided on the Tuesday, Wednesday, Thursday, and Friday before admission What is a benefit of pre-registering patient's for service? - answer>>.Patient arrival processing is expedited, reducing wait times and delays What is a characteristic of a managed contracting methodology? - answer>>.Prospectively set rates for inpatient and outpatient services What is true about screening a beneficiary for possible MSP situations? - answer>>.It is acceptable to complete the screening form after the patient has completed the registration process and been sent to the service department If the patient cannot agree to payment arrangements, what is the next option? - answer>>.Warn the patient that unpaid accounts are placed with collection agencies for further processing In services lines such as cardiology or orthopedics, what does the case-rate payment methodology allow providers to do? - answer>>.Receive a fixed for specific procedures What will comprehensive patient access processing accomplish? - answer>>.Minimize the need for follow-up on insurance accounts Through what document does a hospital establish compliance standards? - answer>>.Code of conduct How does utilization review staff use correct insurance information? - answer>>.To obtain approval for inpatient days and coordinate services When is it not appropriate to use observation status? - answer>>.As a substitute for an inpatient admission What is a serious consequence of misidentifying a patient in the MPI? - answer>>.The services will be documented in the wrong record When a patient reports directly to a clinical department for service, what will the clinical department staff do? - answer>>.Redirect the patient to the patient access department for registration What process can be used to shorten claim turnaround time? - answer>>.Send high-dollar hardcopy claims with required attachments by overnight mail or registered mai