aaham certification programs presenters: kate clark, cpc, cpam i3 healthcare consulting, llc...
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AAHAM Certification Programs
Presenters:
Kate Clark, CPC, CPAM I3 Healthcare Consulting, LLCkate.clark@i3hcc.com 410.979.1624Jennifer Culver, CPAM Global Credit Network, LLCjculver@globalcr.com 301.838.7013Karen Moore, CPAM OPTUMInsightkmoore@caremedic.com 410.754.3293
AAHAM Certification Programs
• Agenda– Brief Overview of Certifications – Exam Formats/Costs– Resources– Updates from National- Kate Clark– Practice Questions/Topics
AAHAM Certification Programs
CPAM Certified Patient Account ManagerCCAM Certified Clinical Account Manager
CPAT Certified Patient Account TechnicianCCAT Certified Clinical Account TechnicianCCT Certified Compliance Technician
Professional Certifications
Technical Certifications
AAHAM Certification Programs Exam Format/Content Format-Time Fees
CPAM4 Sections: Patient Access, Billing, Credit/Collections, Revenue Cycle Mgmt
8 Hrs - T/F, MC, Short Answer, Essay $200
CCAM4 Sections: Front Desk, Billing, Credit/Collections, Revenue Cycle Mgmt
8 Hrs - T/F, MC, Short Answer, Essay $200
CPAT3 Sections: Patient Access, Billing, Credit/Collections 2 Hours- MC
$100 Nat. Members $125 Non
CCAT3 Sections: Front Desk, Billing, Credit/Collections 2 Hours- MC
$100 Nat. Members $125 Non
CCT
4 Sections: OIG Recommendations, 7 Elements of a Compliance Plan, Agencies the Oversee Compliance, Non-Compliance Penalties 1 Hour - MC
$100 Nat. Members $125 Non
Annual Institute- Ocean City, MD September 13, 2011
Certification Stadium
Let the Battle Begin…………
Annual Institute- Ocean City, MD September 13, 2011
ROUND 1“Warm-up”
Annual Institute- Ocean City, MD September 13, 2011
What does the acronym HIPAA stand for?
Health Insurance Portability and Accountability Act
Annual Institute- Ocean City, MD September 13, 2011
What does CMS stand for?
Centers for Medicare & Medicaid Services
Annual Institute- Ocean City, MD September 13, 2011
What is the formula for calculating A/R days outstanding?
Gross A/R divided by (gross revenue for the period divided by the number
of days in the period)
Annual Institute- Ocean City, MD September 13, 2011
What are the seven main points to a corporate compliance plan?
Program oversight, standard procedures, training, monitoring, employee reporting,
enforcement, response
Annual Institute- Ocean City, MD September 13, 2011
How much leave does the FMLA allow employees to take within a 12
month period?
12 weeks
Annual Institute- Ocean City, MD September 13, 2011
What are some methods of forecasting cash?
Historical data on financial class, payments, discounts, payer mix and
days outstanding by payer
Annual Institute- Ocean City, MD September 13, 2011
What do credit balances cause?
Gross A/R is understated
Annual Institute- Ocean City, MD September 13, 2011
What is the difference between fraud and abuse?
Fraud is committed knowingly, abuse is unintentional
Annual Institute- Ocean City, MD September 13, 2011
A balance sheet reflects the company’s financial position?
At specific moment in time
Annual Institute- Ocean City, MD September 13, 2011
What is the formula for net collections?
Net payments/net revenue
Annual Institute- Ocean City, MD September 13, 2011
ROUND 2“Patient Access”
Annual Institute- Ocean City, MD September 13, 2011
What are some of the responsibilities of the Patient Access department?
Primary duty of the front office personnel is to act as a liaison between the physician and the patient Scheduling patient appointments Greeting and checking the patient in Patient check out Insurance eligibility verification
Annual Institute- Ocean City, MD September 13, 2011
What are some of the advantages to having an effective policy for collecting at the
time of service ? Cash flow is improved AR Days are reduced Cost of patient statements is reduced Bad debt is reduced Follow up time is reduced Patient satisfaction can be increased when ‘dunning’ statements don’t have to be sent!
Annual Institute- Ocean City, MD September 13, 2011
Name some things that should be included in a patient information brochure
Location/address/phone number/hours of facility (map) Name & specialties of physician(s) with their degree & Board Certification(s) Medicare participation status HIPAA Notice of Privacy Practices Financial Policy
Annual Institute- Ocean City, MD September 13, 2011
Define the responsibility surrounding the federal anti-dumping legislation
Making sure the transfer can be accomplished without danger or deterioration of the patient’s condition
Determine that the receiving hospital has space and staff to accommodate the patient
Determine that the receiving hospital will accept the transfer and will provide treatment
Make sure the patient or his representative understands the need for and agrees to the transfer
Annual Institute- Ocean City, MD September 13, 2011
Name three types of consents
Written consent Informed consent Implied consent
Annual Institute- Ocean City, MD September 13, 2011
Define Advanced Directives and list the three types
An advance directive is a legal document that explains what kind of medical care you want to receive - or not - if you become ill or injured, and mentally or physically unable to make your own decisions. A Do Not Resuscitate (DNR) order is often part of Advance Directives. The DNR order means that the patient does not wish to have CPR or similar interventions performed in the event of a medical emergency.
The three types of Advanced Directives are: Attorney-in-fact for healthcare Healthcare agent Living wills
Annual Institute- Ocean City, MD September 13, 2011
Name four items that are in the Patient’s Bill of Rights
Right to privacy Right to participate in making decisions about their care Right to continuity of care Right to freedom from abuse
Annual Institute- Ocean City, MD September 13, 2011
What is the formula for the average daily census?
The average # of inpatients maintained in a hospital each day for a specific period
Annual Institute- Ocean City, MD September 13, 2011
Define ABN
An ABN is an Advance Beneficiary Notice. It is used for Medicare patients when services are being ordered/rendered and we expect that they will not be covered. The patient is given the ABN, explained options, and asked to sign the form to accept responsibility for payment. This way the patient agrees to have the test/procedure, knowing s/he will have to pay for it if Medicare denies payment.
Annual Institute- Ocean City, MD September 13, 2011
List 4 items/information that an ABN must contain
The patient’s name, date of service, and a line for the patient’s signature along with the date A description of the services/tests An estimate of the charges A statement that the provider does not believe that Medicare will pay for the servicesAn ABN is not needed when Medicare routinely does NOT pay for the services/tests.
Annual Institute- Ocean City, MD September 13, 2011
What are some of the laws/legislation that help
determine when Medicare is primary? COBRA OBRA TEFRA DEFRA BBA
Annual Institute- Ocean City, MD September 13, 2011
Name four types of HMOs
Staff Model Group Practice Individual Practice Associations or Independent Practice Associations (IPAs) Network
Annual Institute- Ocean City, MD September 13, 2011
Define emancipation and list five ways in which is occurs
Emancipation is when a minor is freed from parental control. Not all states recognize emancipation. Patient Access staff need to be aware of this because it affects issues of consent and financial responsibility. Reaching the age of majority (the age at which an individual is considered an adult and responsible for your actions in the legal sense - in most states this is 18 or 19 years of age) Military enlistment Marriage Court decree Becoming a parent
Annual Institute- Ocean City, MD September 13, 2011
What type of metrics would you use in the Patient Access area?
Registration accuracy Productivity Patient satisfaction
Annual Institute- Ocean City, MD September 13, 2011
Define good controls for cash drawers in the Patient Access
area Maintain a payment log Store payments that have not been deposited in a locked safe Maintain a duplicate numbered receipt log Have a different person balance/close the drawer than is taking the payments
Annual Institute- Ocean City, MD September 13, 2011
ROUND 2Billing
Annual Institute- Ocean City, MD September 13, 2011
Define DMERC and DMEPOS. List 3 different items classified as supplies
DMERC: durable medical equipment regional carrierDMEPOS: durable medical equipment - prosthetics,
orthotics, and supplies Examples of items that are classified as supplies 1. Ostomy supplies2. Surgical stocking3. Oxygen supplies4. Dialysis supplies
Annual Institute- Ocean City, MD September 13, 2011
What are the 3 components that are considered to be the key factors for selecting the level of E/M service?
History Examination Medical Decision Making
Annual Institute- Ocean City, MD September 13, 2011
Which government agency establish policies for reimbursement of
healthcare providers?
Department of Health and Human Services (DHHS)
Annual Institute- Ocean City, MD September 13, 2011
What is the primary goal of the Medicare Integrity Program?
To prevent fraud and abuse
Annual Institute- Ocean City, MD September 13, 2011
Which agencies coordinate the control of Fraud and Abuse ?
OIG and DOJ
Annual Institute- Ocean City, MD September 13, 2011
Name three administrative sanction that CMS can use to address fraudulent behavior.
• Suspension of provider payments• Application of Civil Monetary Penalties (CMP)• Removal of license to practice medicine
Annual Institute- Ocean City, MD September 13, 2011
What does EMTALA stand for?
Emergency medical treatment and active labor act
Annual Institute- Ocean City, MD September 13, 2011
What code identifies the specific date defining a significant event
relating to the bill that may affect payment processing?
Occurrence code
Annual Institute- Ocean City, MD September 13, 2011
What is the patient co-pay amount for SNF day 1-20?
Zero
Annual Institute- Ocean City, MD September 13, 2011
Per CLIA all services furnished to Medicare Beneficiaries must be
performed by a provider who has one of the following certification. These
certificate are:
Certificate of Waiver, Compliance or Lab certification
Annual Institute- Ocean City, MD September 13, 2011
Name a service that is not covered by Medicare Part B
Routine foot care Physical examinations
Annual Institute- Ocean City, MD September 13, 2011
The general co-insurance amount for Medicare part B
patients to pay is?
20%
Annual Institute- Ocean City, MD September 13, 2011
A method of payment for health services by which a healthcare provider is paid a fixed/cap’ed amount for each
person, regardless of the actual number or nature of services provided
is called:
Capitation
Annual Institute- Ocean City, MD September 13, 2011
Capitation is sometimes referred to as:
Per member/per month (PMPM)
Annual Institute- Ocean City, MD September 13, 2011
What is the most common format for a Medicare ID
number?
Nine numeric + one alpha or alpha/numeric
Annual Institute- Ocean City, MD September 13, 2011
ROUND 3Credit & Collections
Annual Institute- Ocean City, MD September 13, 2011
Define skip tracing and list four resources when skip tracing
“Skip Tracking” is the act of locating a guarantor for which you have incorrect contact information. There are 3 main kinds of skips. false skips-which is when the information is wrong due to error on the part of the provider unintentional skips-where the patient forgot to provide updated info intentional skips-when a patient deliberately gave false information with the intent of not paying the debtResources used when skip tracing your own patient accounting system post office internet sites Credit balances
Annual Institute- Ocean City, MD September 13, 2011
Correspondence regarding collection must be retained ___________
years.
7
Annual Institute- Ocean City, MD September 13, 2011
What is the formula for Net Bad Debt?
Net Bad Debt = Net Bad Debt PercentageNet Revenue
Net Revenue = Gross Revenue – Allowances – Charity – Bad Debt – Other Non-Cash Deductions
Net Bad Debt = Bad Debt – Bad Debt Recovery
Net Bad Debt Percentage is the amount of revenue that ultimately gets written off as bad debt. It is important to use net figures because revenue is reduced by contractual allowances, and some bad debt does get recovered
Annual Institute- Ocean City, MD September 13, 2011
When do State collection laws collection laws prevail over
Federal?
When the State law provides more protection
Annual Institute- Ocean City, MD September 13, 2011
What is a legal guardian?
Individual appointed by the court to handle the affairs of another person who is incapable of caring for themselves.
Annual Institute- Ocean City, MD September 13, 2011
The Statue of Limitations is expiring. What can be done to extend the statute?
A.) Obtain a written “promise to pay”B.) Obtain a partial payment on the principle amountC.) Obtain a judgmentD.) All of the above
D. All of the Above
Annual Institute- Ocean City, MD September 13, 2011
Define RFP and list elements to consider when reviewing an RFP.
•Request for Proposal–Bonded–Good reputation–Financially stable–Good public relations–Good business hours–Well trained personnel–Client references–Compliance
Annual Institute- Ocean City, MD September 13, 2011
You are considering the use of a lock box for your hospital. Provide at least three advantages of this system.
•Accelerates the availability of funds•Enhances customer collections•Reduces human error in payment posting•Free up staff for other duties
Annual Institute- Ocean City, MD September 13, 2011
True or False: Under Chapter 13 bankruptcy, an individual who files will have a repayment plan
True
Annual Institute- Ocean City, MD September 13, 2011
What is the formula for Net Recovery & Rate?
Net recovery refers to the percentage of bad debts recovered by a collection agency, after all fees are deducted. To calculate it, take the Total Collected, determine the contingency fee, and subtract it from the Total Collected:
Percent collected = Total Collected Total Referred
Contingency Fee = Total Collected x Contingency Rate
Net Recovery = Total Collected – Contingency Fee
Net Recovery Rate = Net Recovery Total Referred
The net recovery rate tells you what percentage you get back on dollars you place with an agency
Annual Institute- Ocean City, MD September 13, 2011
When was the Fair Credit Reporting Act enacted?
What is it intended to protect? The Fair Credit Reporting Act originally was enacted in 1970 to promote accuracy, fairness, and the privacy of personal information assembled by Credit Reporting Agencies (CRAs). The Act's primary protection requires that CRAs follow "reasonable procedures" to protect the confidentiality, accuracy, and relevance of credit information. To do so, the FCRA establishes a framework of Fair Information Practices for personal information that include rights of data quality (right to access and correct), data security, use limitations, requirements for data destruction, notice, user participation (consent), and accountability. It governs how creditors may report debtor financial information to the Consumer Reporting Agencies. The Fair Credit Reporting Act allows a means for which debtors can correct errors in their records, and it governs who may have access to these records.
Annual Institute- Ocean City, MD September 13, 2011
What is the formula for figuring the most effective collection
agency?
Agency collection x fee= commission Agency collection - commission = Net
collection recovery
Annual Institute- Ocean City, MD September 13, 2011
The Truth in Lending Act is also known as what?
Regulation Z and Title 1 Consumer Credit Protection Act
Annual Institute- Ocean City, MD September 13, 2011
Define Discharge and Dismissal Discharge: order of the bankruptcy court that the petitioner is declared insolvent, assets are liquidated and petitioners are protected from creditors as bankruptDismissal: ruling of the court that the petitioner plea for protection is inappropriate or not supported by the facts. In this case the claim is thrown out, debtor not declared bankrupt, and not protected from creditors.
Annual Institute- Ocean City, MD September 13, 2011
What is the primary objective of making a collection call?
To request payment in full (PIF)
Annual Institute- Ocean City, MD September 13, 2011
ROUND 4AR Management
Annual Institute- Ocean City, MD September 13, 2011
To qualify as a Qualified Medicare Beneficiary (QMB) an individual must
Be enrolled in Medicare part A & B Not exceed a specified level of financial resources Have a annual income of not more than 100% of the federal poverty level
Annual Institute- Ocean City, MD September 13, 2011
What is a group of standards and guidelines used in preparing financial
reports called?
Generally Accepted Accounting Principles (GAAP)
Annual Institute- Ocean City, MD September 13, 2011
The limiting charge for Medicare for a non-participating physician is ____ of the
fee schedule.
115%
Annual Institute- Ocean City, MD September 13, 2011
Improve cash flow, reduce costs of borrowing money if necessary,
reduce bad dept losses are reasons for _____________________of
patient accounts.
Effective Management
Annual Institute- Ocean City, MD September 13, 2011
Explain the different of payment methods.
Capitation: patients are assigned a provider and payment is made according to contract whether the patient is seen or cared for. Usually paid on a per member/per month basis.All inclusive: One rate that includes all the services provided to a patient receives during a period of time.Per Diem: Amount determined for each inpatient for each day in the facilityIndemnity: Line item paymentDRG: Payment assigned by patient age, diagnosis, severity, co morbidity, and discharge disposition
Annual Institute- Ocean City, MD September 13, 2011
If the accounts receivable balance is $820,000 and the average
adjustment is 30%. What would be the anticipated value of the
AR?
$574,000
Annual Institute- Ocean City, MD September 13, 2011
A new computer system would be considered what type of
expense?
Capital expense
Annual Institute- Ocean City, MD September 13, 2011
Give three examples of Fraud and three examples of Abuse
Fraud1. Billing for services not rendered2. Misrepresentation of service or coding3. Misrepresentation of a diagnosis 4. KickbacksAbuse5. Over utilization of services not medically necessary6. Violation of assignment7. Waiving coinsurance or deductibles8. Screening services
Annual Institute- Ocean City, MD September 13, 2011
Define cash forecasting
Cash forecasting is the projection of cash flow for the future based on historical trends and/or anticipated changes
Annual Institute- Ocean City, MD September 13, 2011
List 5 factors in forecasting cash both internal and external indicators
1. Historical data2. Changes in payer mix3. Seasonal trends4. Billing back logs5. Increase/decrease patients6. Economic indicators
Annual Institute- Ocean City, MD September 13, 2011
What are some methods to follow in order to increase cash flow?
Increase collection activity Use prompt payment discounts Decrease the bill hold days Institute time of service collections
Annual Institute- Ocean City, MD September 13, 2011
Services to Medicare patients can be paid when provided by a Locum Tenens
physician. What conditions need to be meet in order for this to occur?
The patient’s regular physician unable to provide the visit service The patient had a previously scheduled appointment or treatment with their regular physician A substitute physician does not provide services for the patient for over 60 days
Annual Institute- Ocean City, MD September 13, 2011
What is the difference between a Medicare Risk Basis HMO and
a Medicare Cost HMOMedicare Risk Basis HMO: HMO has jurisdiction for all claims Beneficiaries must receive their services through the HMO All claims submitted to Medicare will be deniedMedicare Cost Base HMO: Beneficiaries may receive care within and outside the HMO Claims covered by the HMO submit to HMO Services obtained outside the HMO submit to the Medicare carrier for payment.
Annual Institute- Ocean City, MD September 13, 2011
What are the elements of a Charge Master?
Department numbersRevenue codesCharge master numbersCharge description Charge amountsHCPCS codesModifiersGeneral ledger numbers
Annual Institute- Ocean City, MD September 13, 2011
How do you distinguish between bad debt and charity care on a financial
statement?
Bad debt is defined as an expenseCharity care is defined as a deduction from revenue (indicated as footnote on the income statement)Patient service revenue are AR should be reported net of contractual allowances and not included in charity care
Feel free to contact us with any questions.
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