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What is the 1st component in the revenue cycle?
Preclaims submission activities
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How are charges for healthcare at all of the points of services collected & reported to the appropriate patient account for entry onto provider's claim.
Electronic order entry,if the facility has it, if not then good old fashion paperwork.
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What is the function of scrubbers in the claims processing component of the revenue cycle?
To catch errors that could cause the claim to be delayed or denied.
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List the basic data elements of a CDM, identifying which data elements are hospital specific & which are nationally recognized.
Code charge-facility, Dept. code-facility, Revenue code-national, CPT/HCPCS codes-national, Charge description-facility, Charge/price-facility.
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Discuss how NCDs are different from LCDs
NCDs describe the circumstances in which specific medical supplies, services or procedures are covered nationwide by Medicare. LCDs describe what Medicare deems medically necessary by region.
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Healthcare facilities should design key performance indicators so that they ______.
Set a standard or a baseline for improvement
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Identify 1 MAP KPI & identify the revenue cycle it represents.
Point of service cash collection-patient access
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What are the 3 benefits of an integrated revenue cycle?
Reduce cost to collect, performance consistency, coordinated strategic goals
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What system is typically used to audit outpatient Medicare claims?
Medicare Integrated Outpatient Code Editor (OCE)
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In MS-DRG relationship reporting, MS-DRG families are examined for_____.
CC--diagnosis of a complication or comorbidity, MCC--diagnosis of a major complication or comorbidity
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