It replaces the "Patient's Bill of Rights.'
It was adopted by the AHA
It outlines what a provider can expect from a patient.
It is a plain-language brochure.
It addresses patient expectations from admission to dismissal only.
It refers only to any single piece of data that could directly match patients with their medical information.
It can be shared without explicit consent for treatment, payment, or healthcare operations (TPO).
It cannot be shared for marketing purposes without explicit consent.
It cannot be shared with law enforcement agencies without consent or proper notification to the patient, expect under court order.
Patient Care Partnership brochure
Healthcare Power of Attorney or Durable Power of Attorney for Healthcare.
Denial or revocation of the provider number applications.
Suspension of provider payments.
Application of CMPs.
Inclusion in a published "watch" list of providers.
All hospitals must be accredited by TJC.
TJC will conduct an audit of a hospital every 39 months.
TJC will conduct an audit of a laboratory every 36 months.
TJC can audit a healthcare facility without advance notice as early as 6 months after its initial audit.
Assignment of benefits
Authorization of payments
The person is an emancipated minor.
The person is uninsured.
The person is intoxicated.
The person is declared mentally incompetent by the courts.
A physician extender
A licensed, registered nurse
A financial counselor
A student from an accredited health profession program (under the supervision of his or her clinic instructor.
National Coverage Determination
National Coverage Department
New Coverage Determination
New Coverage Direction
Until 2010, Medicare was the primary payer for nearly will Medicare-covered services.
Before becoming entitled to Medicare, beneficiaries receive an IEQ that asks about any other healthcare coverage that might be primary to Medicare.
Medicare considers it a fraudulent or abusive practice to regularly submit claims that are the responsibility of another insurer under the MSP provision.
The CWF is a CMS file that contains Medicare patient eligibility and utilization data from the IEQ and ongoing MSPQs.
They should describe the provider's policies in general terms only to allow for flexible legal interpretation
They should clearly state when charges are due and payble; provide discount information; define acceptable methods of payment; outline charity guidelines and application procedures; and explain how accounts may be sent to a collection agency.
Patient Access/Front Desk staff should not discuss these policies with patients; instead, they should refer patients to a designated Billing staff member.
An effective policy for collecting at the time of service will improve cash flow and will reduce AR days, the cost of patient statements, bad debt, and follow-up time.
It is also known as the benefit period
It is also known as the deductible period
It begins when a beneficiary enters the hospital and ends 30 days after discharge from the hospital or from a SNF
It begins when a beneficiary enters the hospital and ends 60 days after discharge from the hospital or from a SNF
Chiropractic services (limited)
Routine eye care and most eyeglasses in the absence of disease
Kidney dialysis and kidney transplants
Hearing aids and exams
Use of program practitioners
Use of specific healthcare facilities
State-mandated coverage limits
They are the private firms that process Medicare claims
They were formerly known as fiscal intermediaries or carriers
They enroll providers in the Medicare program, provide education on Medicare billing requirements, and answer both provider and patient inquiries
There is one MAC in each of the 50 states