Term
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Definition
Panning
Directing
Leading |
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Term
| Planning components of management |
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Definition
strategic planning
budgeting
research trends |
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Term
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Definition
Human resources
Natural resources
Capital resources |
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Term
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Definition
Share vision
Motivate others |
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Term
| Reason for management of Patient Accounts |
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Definition
improved cash flow
reduced bad debt losses
improve patient satisfaction |
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Term
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Definition
minimize lost charges
right off for noncollectable accounts
minimize account receivable collections
cycle (days in AR)
time to collect money |
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Term
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Definition
| When it is know that services will be surrender. Patients should know ASAP their financial responsibilities. |
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Term
| Financial Policies goal is to? |
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Definition
Notification of patient responsibility
Preserve reputation and the fiscal health of the provider
ways account balances should be resolved |
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Term
| Topics in a good financial policy |
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Definition
expectation for collection at time of service
means for determining patient's financial need
guidelines for financial assistance
follow-up parameters
how accounts are deemed noncollectable |
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Term
| Financial policy ensures? |
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Definition
every patient's account receives consistent treatment
offers a clear signal to employees intentions of being paid and willingness to help patient's meet financial goals |
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Term
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Definition
| How long it takes to collect revenue from the date of discharge. |
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Term
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Definition
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Term
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Definition
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Term
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Definition
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Term
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Definition
Discharge not Final Bill
Patient completed treatment but claim has not been processed |
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Term
| State common reason for DNFB |
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Definition
Incomplete medical records
Staff shortage
Physician dictation |
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Term
| State reason AR day can be increased |
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Definition
| Backlog due to physicians failing to complete and sign dictation |
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Term
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Definition
| The number of days a bill is allowed to sit before the claim drops |
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Term
| Define reasons for bill hold |
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Definition
To assure all charges are in
To check for other accounts in relation to the 72 hour rule |
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Term
| How long should a bill hold be? |
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Definition
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Term
| What item can delay a bill being processed? |
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Definition
Systems issues
Incorrect mapping or edits problem
Staff shortage or inefficiencies |
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Term
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Definition
| Putting information into the wrong data fields |
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Term
Define chargemaster
AKA Service item master |
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Definition
| A listing of all charges that might be posted to a potential account |
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Term
| Define elements of a chargemaster |
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Definition
Each system has entry that includes information about description and pricing of services
Contains CPT and revenue codes
General Ledger accounts are often inventoried to update suppler and cost |
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Term
| State importance of updating the chargemaster |
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Definition
Accurate claims
Compliant claims
To ensure revenue opportunities are not overlooked
Generally overseen by a charge master committee |
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Term
| State elements of a legal contract |
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Definition
Offer
Acceptance
Consideration
Legal purpose
Mutuality
Competence |
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Term
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Definition
| Includes the hiring, firing, evaluating personnel record keeping of employee files |
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Term
| Define components of Progressive Disciplinary Action |
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Definition
Employee knows what is expected
Documentation employee is not meeting expectations
Discipline can start with verbal warning or coaching
Discipline such as a written warning and suspension with/out pay
Termination |
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Term
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Definition
American with Disabilities Act, 1990
Prohibits discrimination on the job if a disability can be accommodated |
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Term
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Definition
Family Medical Leave Act, 1993
Employers of 50 or more allows a person who works at least 1250 hours in the last 12 months to take up to 12 weeks of leave due to a medical condition of himself or a family member, birth or adoption |
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Term
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Definition
| Unlawful action against an employee based on age, sex, race, marital status, pregnancy or disability |
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Term
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Definition
Conduct that makes the workplace disturbing or threatening
Unwanted advances, racially charged jokes, explicit emails, etc.
Training should be provided to employees regarding expected behavior in the workplace and how to respond to harassment |
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Term
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Definition
| Standard means of measuring the day-to-day activities and results of the business |
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Term
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Definition
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Term
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Definition
| Things the business own that has value |
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Term
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Definition
| Cash and items that can easily be turned into cash |
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Term
| State Current Asset types |
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Definition
Receivables
Checking account balances |
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Term
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Definition
| Asset that can not be easily turned into cash |
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Term
| State Capital Asset types |
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Definition
Land
Buildings
Large equipment |
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Term
|
Definition
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Term
|
Definition
| The difference between assets and liabilities |
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Term
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Definition
| Providing a service and generating a charge |
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Term
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Definition
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Term
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Definition
| A business paying on debt |
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Term
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Definition
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Term
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Definition
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Term
| Define 2 special consideration to accounting |
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Definition
Charity- is a reduction from revenue because it is not expected to be collected
Bad debt- an expense and will be deducted from income |
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Term
| Define accounting posting |
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Definition
Debits = left
Credits = right |
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Term
| Two types of Accounting methods |
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Definition
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Term
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Definition
| Revenue is booked at the time it is charged and expenses are booked as they are incurred even if they are not yet paid |
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Term
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Definition
| Revenue is booked at the time it is charged and expenses are booked as they are incurred even if they are not yet paid |
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Term
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Definition
Revenue booked when collected
Expenses booked when paid |
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Term
Define GAAP
General Accepted Accounting Principles |
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Definition
| Rules used to standardized accounting practices so that all interested parties are able to understand financial reports |
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Term
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Definition
| Internal method of accounting for the actual cost of providing various goods and services |
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Term
| Define Balance Sheet statement |
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Definition
Shows assets - liabilities = owners equity or retained earnings
A snapshot of the business |
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Term
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Definition
Shows revenue - expense = profit
Recorded overtime |
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Term
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Definition
| A plan of how the business will meet its goals in a future period |
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Term
| Budgeting methods may include |
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Definition
Review of past results
Comparing them to the expectations for the future |
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Term
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Definition
A spending plan for expensive items
Shows cash flow needs for a particular time |
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Term
| Define Asset Control protection methods |
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Definition
Individual cash drawer handling
Cash drawers balanced each shift
Receipt for all cash payments
Segregation of duties
Entries balanced daily
Bonded personnel |
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Term
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Definition
| Developed to help a provider avoid, find and remedy instances of noncompliance with rules and regulation |
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Term
| Define elements of Compliance Plan |
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Definition
Written policies and procedures
Designated Compliance Officer and compliance committee
Effective training and education
Effective lines of communication
Enforces standard and well publicized disciplinary procedure
Auditing and monitoring
Responding to offenses and developing corrective |
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Term
| Define Compliance Plan guidelines |
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Definition
Ethics and of conduct
Duties and reporting structure
Anonymous reporting mechanism
Compliance education
Handling non-compliance
Clearly state expectations |
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Term
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Definition
Accounts with a negative balance
Credit balances cause assets to be understated
Insurance companies often have contractual credit balance handling terms |
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Term
| Reasons for credit balances |
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Definition
Incorrect coordination of benefits
Duplicate Insurance payments
Patient and Insurance paying
Charges credited after billing drops
Posting mistakes |
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Term
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Definition
| Medicare requires hospitals to submit quarterly credit balance reports regardless of balances |
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Term
| Elements of contract negotiation |
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Definition
Pre-authorization requirements
Refund policy
Prompt payment
Timely filing
Outliers and stop-loss clauses
Bad debt allowances
Insolvency
Reselling of discounts |
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Term
| Define reasons for contracts |
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Definition
Payer discounts
Provider expects to gain volume
Preferred provider co-payments
Large payers provide little gain |
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Term
| Define a method to monitor accuracy of payments received |
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Definition
| Random sampling of payment with a comparison of the anticipated versus the actual reimbursement |
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Term
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Definition
| Charges that are placed on an account after the bill has been billed |
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Term
| Methods of handling late charges |
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Definition
Rebilling causing delays in account resolution
Written-off |
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Term
Define RAC
Recovery Adult Contractor |
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Definition
Identify under and over payments in the Medicare program
Charges a contingency fee of $2 for every $10 recovered |
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Term
| State 3 states with the highest Medicare utilization |
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Definition
CA
FL
NY
First states to use demonstration of RACs |
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Term
| Changes made to RAC include |
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Definition
Limiting the look back period
Providing provider education
Changes to contingency fee structure |
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Term
| State two types of RAC review |
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Definition
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Term
| Define Automated RAC review |
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Definition
| RAC identifies potential issues using its databases to find improper payments then obtains notification of denial claims |
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Term
| Define Complex RAC review |
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Definition
| RAC request medical records and make a determination from them |
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Term
| Define RAC appeal time frame |
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Definition
| Providers have 15 days to question any denials then undergo the regular appeals process |
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Term
| Functions of RAC Committees |
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Definition
Plan responses to denials
Find ways to track activity
Perform internal audits |
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Term
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Definition
| Using an outside entity for a particular job function performed in-house |
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Term
| Types of revenue cycle outsourcing |
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Definition
Pre-registration
Billing
Early-out programs
Insurance follow-up
ERA pick-up
Statement mailing |
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Term
| Things that should be consider prior to outsourcing |
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Definition
Cost vs. benefit
Making sure process work correctly
Desired results and monitor process
Must compare products periodically |
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Term
| State methods to evaluate the condition of a business |
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Definition
Accounting metrics for creditworthiness
Internal metrics to gage effectiveness of the revenue cycle |
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Term
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Definition
| Average daily revenue over a period of time divided by current AR |
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Term
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Definition
| How long you could keep paying bills if cash stopped coming in |
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Term
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Definition
| Cash on hand/ [(total operating expenses-depreciation)/365] |
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Term
| The calculation of AR days are performed how often? |
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Definition
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Term
| Identify 5 short-term steps to correct a backlog |
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Definition
Identify the major problem area
Review workloads, backlogs, skill level and staff ratio
Develop two teams; one to handle backlogs and the other to handle current AR
Outsource a portion of the work load
Review medical record coding and incomplete chart delays |
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Term
| Type of statement serves to explain the source of changes in cash accounts |
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Definition
| The statement of cash flows |
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Term
| A not- for- profit hospital incurs a profit at the end of the year. How are profits to be handled? |
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Definition
| Profits may be retained and used to fund future operations and invest in new equipment |
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Term
| The accounting entry to post the write-off of a charitable account is |
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Definition
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Term
| A hospital recognizes revenue for services at the moment that a claim are generated even though the patient has not yet been billed. What accounting method is utilized? |
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Definition
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Term
| Define Zero based budgeting |
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Definition
| Budgeting that requires all management levels to start from zero and estimate budget data as if none previously existed |
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Term
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Definition
| Enacted in 1996, creates standard for insurers, HMOs and employers plans; contains broad anti-fraud and abuse provisions; and improve the availability of health insurance to working families sand their children through access and portability requirements |
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Term
| Define Pro-Forma Statement |
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Definition
| A statement detailing managements financial projection for the future |
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Term
| Items needed by employer to comply with ADA stature |
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Definition
Must ask applicants if they are disabled
Revise employment application and job description to incorporate ADA requirements
Modify the physical work environment to reflect ADA requirements
Post ADA notice for all employees |
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Term
| Define Anti-trust Legislature |
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Definition
| Guidelines identify several anti-trust "safety zones" for engaging in collective activities, mergers and joint ventures meet requirements specified within a "safety zone" is considered permissible. |
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Term
Define APC
Ambulatory Payment Classification |
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Definition
All services paid under the new Prospective Payment System (PPS) contain 659 APCs divided by significant procedures, medical services, ancillary services and partial hospitalization
Payment rates have been established for each APC |
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Term
| Code type required for submitting claims for AS, RAD, ER, Pharmacy, Clinics |
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Definition
| CPT/HCPCS codes and service units |
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Term
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Definition
| Ambulatory surgical claims submitted for OPPS by hospitals |
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Term
| Preoperative lab services must always include |
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Definition
Line item date of service within the from and thru date of the claim and reflect the earliest
date services were rendered |
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Term
|
Definition
Replaced 83X
Ambulatory surgical claims submitted for OPPS by hospitals |
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Term
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Definition
| Indian Health Services providers billing for surgeries |
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Term
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Definition
| All related services on one claim |
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Term
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Definition
| Number of times the service reported was performed according to HCPCS code definition |
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Term
| Define unit components regarding billing |
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Definition
Hospital should not bill for less than 8 min
Total number of units billed needs to be equal to total treatment time as per medical record |
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Term
Define ATB
Age Trail Balance |
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Definition
Designed to break the receivable into several categories grouped according to age of receivable
Allows manager to asses how old the receivable is and its collectivity according to age |
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Term
| Element in included in a ATB |
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Definition
Patient's name
Admit and discharge dates
Financial class
Type of service
Payment posted
Number of statement generated
Insurance Balance
Patient balance
Bill date |
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Term
| What are the general accounting principles to be applied to cashier functions? |
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Definition
Checks stamped "For Deposit Only" immediately
Cash posted on the same day received
Separate cash box and impressed fund per cashier
Store un-deposited cash and valuables in fire proof safe
Maintain duplicate number receipt log |
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Term
| List typical cash-generated revenue to control with policy and procedure |
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Definition
Time of service collection in the form of cash, checks or credit card
Patient walk-in into the cashier's office
The facility bank cash collection obtained by lockbox
The reconciliation of credit card transactions
Patient and Third party payers via direct making address other than lockbox |
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Term
Classify the following transactions as debit or credit
Charge to an account |
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Definition
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Term
Classify the following transactions as debit or credit
Contractual Allowance |
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Definition
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Term
Classify the following transactions as debit or credit
Payment made on account |
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Definition
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Term
Classify the following transactions as debit or credit
Bad debt write-off |
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Definition
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Term
Classify the following transactions as debit or credit
Refund |
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Definition
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|
Term
Classify the following transactions as debit or credit
Charity care |
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Definition
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|
Term
Classify the following transactions as debit or credit
Interest and Finance Charges |
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Definition
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Term
| What are some common debit and credit rules? |
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Definition
All debits must equal all credits
Debits are increased to assets and expenses
Credits are increased to liabilities, equity and revenue
Debits are decreases to liabilities, equity and revenue
Credits are decreases to assets and expenses |
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Term
Define DSH
Disproportionate Share Hospital |
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Definition
| Hospital with a disproportionately large share of low-income patients |
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Term
| List sources of miscommunication between director and staff |
|
Definition
Objectives
Timeframes
Duties
Changes
Policy
Priorities |
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Term
| What are some key components of a Patient Financial Service Operational Manual |
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Definition
Policy and procedures
Organization chart
Job description
Competency assessment
Performance appraisal forms and evaluation process
Disaster plan
Security plan
OSHA and safety rules
JACHO required plan
New hire orientation checklist |
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Term
What is FLSA and what does it impact
The Fair Labor Standards Act |
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Definition
Establishes minimum wage, overtime pay,record keeping and child labor standards
Covers non exempt workers are entitled to a min wage of $5.15 /hr and overtime rate of not less than one and 1/2 of their regular rates after 40 hrs of work in a work week |
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Term
| What is the importance of interfacing accounts receivable with the general ledger? |
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Definition
Ensure all transactions post properly in the general ledger
Ensure charges are credited to correct revenue producing departments
Ensure accuracy of cost reports
Overall well being of facilities financial statement |
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Term
What is HCQIA
Health Care Quality Improvement Act, 1986 |
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Definition
| Established Peer Reviews Organizations (PRO) for review of credentialing |
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Term
| What should be considered when evaluating financial information systems and vendors |
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Definition
Can staff oust a transaction batch a time or multiple batches at once?
Can staff post multiple items in one account at the same time
How long does it take to set up a new account?
How fast can staff look up a patient number by patient name?
Are manual easy to understand?
What training is included with purchase
Does vendor have a support line for questions? |
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Term
| What should be considered when choosing an electronic claims processing system? |
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Definition
Does the system have a reporting menu?
Does the system allow mangers to customize bill reports?
Can reports be printed an assessed for up to 6 months?
Does the system allow on-line history ans access to all claim?
Does the system generate daily error reports?
Does the system allow a user to access and print all programmed billing edits by payer?
Does the system interface with the current patient accounting system? |
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Term
| List common reasons ROI is not realized after purchase of new technology? |
|
Definition
Miscommunication between various departments
Insufficient training
Lack of processing procedures
Interface issues
Staff turnover
Poor vendor management
Budget constraints
Poor ongoing maintenance of system
Modifications necessary to meet requirements |
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Term
| List three phases of emergency planning |
|
Definition
|
|
Term
| Contingency plans should address what issues? |
|
Definition
Personnel
Date
Software
Communication
Supplies
Space
Documentation |
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Term
| How does the contingency plan impact patient access |
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Definition
| In the event of a disaster it helps to protect lives, reduce operational damage, ensure quick recovery of systems, modifies admission and discharge functions to meet the need of the department |
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Term
| What are some JCAHO survey policy changes? |
|
Definition
No advance notice
Surveys may be conducted within 9-30 months following a full triennial survey
Survey will vary depending upon triennial survey |
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Term
| Define some actions PFS department should take to monitor manage care contracts |
|
Definition
Educate staff o contract payment plans
Conduct routine audits of all MCC and payments
Investigate and recommend software that monitor payments
Train registration staff and financial counselors to identify potential MCC
Initiate MC task force to discuss problems |
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Term
| Define Master Patient Index |
|
Definition
| A computerized database containing medical and administrative patient information such as demographics, insurance, credit, receivables, appointments and medical data |
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|
Term
| What is a Medicare Focus Review? |
|
Definition
| The process of targeting and directing medical review efforts toward MCR claims that are at risk for inappropriate program payments in order to reduce claims for uncover or unnecessary services |
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|
Term
| What are the requirements for claiming Medicare bad debt? |
|
Definition
| Account must be written of the books for 121 days after the final bill date and collection agency has ceased collection efforts |
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|
Term
|
Definition
|
|
Term
|
Definition
| Workers are lazy and need close supervision |
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Term
|
Definition
| Workers provide input and work in a team |
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Term
| Guidelines that should be considered by PFS to ensure proper handling of MCR bad debt |
|
Definition
Ensure proper collection efforts of MCR deductibles and coinsurance
Ensure collection referral
Document all collection efforts
Ensure collection agency ability to process claim
Maintain written policy on collection guidelines
Logs should be forwarded to designated party for cost report entry |
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Term
| Define Medicare Credit Balance Reporting Requirements? |
|
Definition
| A form 838 is required to report credit balances quarterly of an improper or excessive payment made to the provider |
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|
Term
| What is a MCR common working file? |
|
Definition
| A CMS file, 1990 that contain Medicare patient's eligibility an utilization data |
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|
Term
| Typical MSP information that may be assessed via CFW includes |
|
Definition
MSP effective date
MSP termination date
Patient relationship
Subscriber relationship
Subscriber policy number
Insurer type |
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|
Term
| List three primary objectives of accounts receivable management |
|
Definition
Minimize lost charges
Minimize write-offs
Minimize accounts receivable collection cycle |
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|
Term
| List reasons why patient account management is important in a hospital and clinical environment |
|
Definition
Improved cash flow
Reduced bad debt losses
Improve management approach
Improve patient satisfaction
Reduce the cost of borrowing money if needed |
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