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CHAM ARRIVAL REVENUE CYCLE NEWEST
2025 ACTUAL EXAM COMPLETE 100
QUESTIONS AND CORRECT DETAILED
ANSWERS (VERIFIED ANSWERS) |100%
GUARANTEED PASS!
Notice Law- Passed in March of 2015 requires hospitals to provide observation patients who have a outpatient observation stay of more than 24 hours an adequate oral and written notification within - ANSWER-36 hours after being placed in observation.
Hospital's will be required to: Explain the individual's
status as an outpatient and not as an i - ANSWER-npatient and the reasons why; *Explain the implications of that status on services furnished, in particular the implications for cost-sharing requirements and subsequent coverage eligibility for services furnished by a skilled nursing facility; o is written and formatted using plain language and made available in appropriate languages; o is signed by the individual or a person acting on the individual's 1 / 4
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behalf (representative) to acknowledge receipt of the notification, or if the individual or representative refuses to sign, the written notification is signed by the hospital staff who presented it.
Utilization review (UR) monitors the use of - ANSWER- resources, reviews stays and is a safeguard against unnecessary and inappropriate medical care
The UR nurse will manage and monitor the case through- out the course of the stay ensuring all needed services are provided in a - ANSWER-timely manner. They may arrange education for the patient and family.
UR assists with review of - ANSWER-medical necessity, quality of care, appropriateness of decision making, place of service, and length of hospital stay.
Types of Utilization Review - ANSWER-*Prospective - A review of the patients proposed care plan, prior to provision or service or entry into the facility. Used to 2 / 4
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determine if medical necessity requirements will be met.*Concurrent- a review of the patient's plan of care and resource needs real time while patient is an
Discharge planning begins as soon as the patient is - ANSWER-admitted into a facility, the discharge planner is working with Case Management, UR and care providers to manage the entire patient stay and move the patient out of acute care as soon as medically possible.
The discharge planner considers: - ANSWER-*Estimate
the LOS based on assigned DRG. *Will there be any delays with discharge? *What needs to be facilitated in order to discharge the patient, will they need post-acute care such as SNF, Home Care or Hospice services?
In collaboration with Case Management, an effective Utilization Review program can help healthcare
organizations: - ANSWER-*Position the organization for
changes under healthcare reform with coordination of care across the healthcare continuum *Enhance quality of 3 / 4
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care with interdisciplinary team focus on the progression of the plan of care *Increase payment and decrease costs by expediting patient discharge *Improve the revenue cycle process by ensuring accurate coding for prompt billing, reducing denials, and improving contracting terms with managed care payers. *Proactively prepare for Recovery Audit Contractor (RAC) audits and protect against take backs.
Medical Documentation is required to record pertinent facts, findings and observations about a person's - ANSWER-individual health history, including; past and present illnesses, examinations, tests, surgeries, other treatments and outcomes. The record chronologically documents the care the person has received.
Due to meaningful use requirements a vast majority of hospitals have transitioned to - ANSWER-electronic health records (EHR) and all federal and state requirements still apply.
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