Business Office Assessment

Question 1

Private Payor accounts can be collected in advance with the exception of which private payer (s)?

Answer 1

Medicare CoInsurance from Private

Question 2

Which Payor Type can we collect coinsurance in advance?

Answer 2

HMO/Medicare Adv Health plans

Question 3

When should the resident be notified of their co-pay amount due?

Answer 3

upon admission (within 48hrs and weekly billing with follow up

Question 4

Per our collections policy the_____th day of the month is considered past due on a continuing monthly private payer account?

Answer 4

10th

Question 5

The 1st collection letter should go out to current in-house residents by the ______ of the month?

Answer 5

20th

Question 6

All collection activity; phone calls, collection letters, any correspondence from the resident or responsible party should be clearly documented where?

Answer 6

PCC Collection Module - Resident

Question 7

Best practices if the BOM has sent out the statement with the due date for payment and collection calls collection letters have been sent out the _________ would get involved?

Answer 7

ED

Question 8

When should Medicare coinsurance from insurance be moved to Medicare coinsurance from private if not originally booked as such?

Answer 8

Upon receipt for of the insurance EOB be notifying the facility that they will not pay coinsurance

Question 9

What email address do you use in order to request an asset search?

Answer 9

Assetsearch@ensignservices.net

Question 10

A resident who exhaust all 100 days in a skilled nursing facility but is still receiving skilled care services must submit what type of claim to Medicare monthly?

Answer 10

Benefit exhaust clamp

Question 11

A resident becomes eligible for Medicare part A benefits on 12/1/16 and was in the hospital as inpatient from 11/ 25/16 to 11/30/16 can be covered under Medicare part A for their admission on 12/3/16? Yes or no?

Answer 11

No resident must have a three day stay once they are eligible for part a benefits

Question 12

Occurrence span code WHAT is used when part of a residence day is considered provide reliable?

Answer 12

77

Question 13

Occurrence code WHAT is used on the UB04 to identify when a resident skilled level of care is ended along with the date active care ended

Answer 13

22

Question 14

Medicare part a no pay claims are billed with WHAT type of bill and condition called WHAT

Answer 14

210, 21

Question 15

Value code 80 is
Value code 81 is
Value code 82 is
Value code 09 is

Answer 15

• Total number covered days
• Total number non-covered days
• Total number coinsurance days
• Medicare coinsurance amount

Question 16

When checking claims in DDE; status code_____Means returned to provider

Answer 16

TB

Question 17

What function key in DDE do you hit to find the reason a claim has been returned to provider or RTP?

Answer 17

F1

Question 18

What criteria must be met in order for a resident to regenerate a new 100 day benefit?

Answer 18

60 consecutive days of wellness that are not at a skilled level of care