AAHAM Certification Programs

1. AAHAM Certification Programs Presenters: Kate Clark, CPC, CPAM I3 Healthcare Consulting, LLC kate.clark@i3hcc.com410.979.1624 Jennifer Culver, CPAM Global Credit Network, LLC jculver@globalcr.com 301.838.7013 Karen Moore, CPAM OPTUMInsight kmoore@caremedic.com 410.754.3293

2. AAHAM Certification Programs • Agenda • Brief Overview of Certifications • Exam Formats/Costs • Resources • Updates from National- Kate Clark • Practice Questions/Topics

3. AAHAM Certification Programs

4. AAHAM Certification Programs

5. AAHAM Certification Programs Resource: www.aaham.org- Certification Section

6. Certification Stadium Let the Battle Begin…………

7. ROUND 1“Warm-up”

8. What does the acronym HIPAA stand for? Health Insurance Portability and Accountability Act

9. What does CMS stand for? Centers for Medicare & Medicaid Services

10. 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)

11. What are the seven main points to a corporate compliance plan? Program oversight, standard procedures, training, monitoring, employee reporting, enforcement, response

12. How much leave does the FMLA allow employees to take within a 12 month period? 12 weeks

13. What are some methods of forecasting cash? Historical data on financial class, payments, discounts, payer mix and days outstanding by payer

14. What do credit balances cause? Gross A/R is understated

15. What is the difference between fraud and abuse? Fraud is committed knowingly, abuse is unintentional

16. A balance sheet reflects the company’s financial position? At specific moment in time

17. What is the formula for net collections? Net payments/net revenue

18. ROUND 2“Patient Access”

19. 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

20. 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!

21. 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

22. 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

23. Name three types of consents Written consent Informed consent Implied consent

24. 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

25. 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

26. What is the formula for the average daily census? The average # of inpatients maintained in a hospital each day for a specific period

27. 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.

28. 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 services An ABN is not needed when Medicare routinely does NOT pay for the services/tests.

29. What are some of the laws/legislation that help determine when Medicare is primary? COBRA OBRA TEFRA DEFRA BBA

30. Name four types of HMOs Staff Model Group Practice Individual Practice Associations or Independent Practice Associations (IPAs) Network

31. 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

32. What type of metrics would you use in the Patient Access area? Registration accuracy Productivity Patient satisfaction

33. 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

34. ROUND 2Billing

35. Define DMERC and DMEPOS. List 3 different items classified as supplies DMERC: durable medical equipment regional carrier DMEPOS: durable medical equipment - prosthetics, orthotics, and supplies Examples of items that are classified as supplies Ostomy supplies Surgical stocking Oxygen supplies Dialysis supplies

36. 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

37. Which government agency establish policies for reimbursement of healthcare providers? Department of Health and Human Services (DHHS)

38. What is the primary goal of the Medicare Integrity Program? To prevent fraud and abuse

39. Which agencies coordinate the control of Fraud and Abuse ? OIG and DOJ

40. 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

41. What does EMTALA stand for? Emergency medical treatment and active labor act

42. What code identifies the specific date defining a significant event relating to the bill that may affect payment processing? Occurrence code

43. What is the patient co-pay amount for SNF day 1-20? Zero

44. 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

45. Name a service that is not covered by Medicare Part B Routine foot care Physical examinations

46. The general co-insurance amount for Medicare part B patients to pay is? 20%

47. 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

48. Capitation is sometimes referred to as: Per member/per month (PMPM)

49. What is the most common format for a Medicare ID number? Nine numeric + one alpha or alpha/numeric

50. ROUND 3Credit & Collections