Registration Procedures Flashcards

Which form must be completed when Medicare may not cover a service because it may be deemed not medically necessary?

Answer: Advance Beneficiary Notice of Noncoverage (ABN)

The ABN must be provided to Medicare beneficiaries before rendering services that may be denied for medical necessity, so the patient can decide whether to proceed.

When verifying insurance eligibility, which of the following is the MOST critical piece of information to confirm?

Answer: Whether the patient's coverage is active on the date of service

Confirming active coverage on the date of service ensures the claim will not be denied due to lapsed or terminated insurance.

A patient is admitted as an inpatient. Under Medicare, how long must a patient be kept under physician orders for inpatient admission before Part A covers the stay?

Answer: 2 consecutive days (2-midnight rule)

Medicare's Two-Midnight Rule states that inpatient admission is generally appropriate when the physician expects the patient to require hospital care spanning two midnights.

Which registration error most commonly leads to claim denials related to patient identity?

Answer: Transposing the patient's date of birth or misspelling the name

Incorrect date of birth or name spelling is a top cause of eligibility mismatches and claim denials because payers match members by exact demographics.

What is the purpose of collecting an emergency contact during patient registration?

Answer: To have a responsible party to contact in the event of a medical emergency or when the patient is incapacitated

An emergency contact allows staff to reach a trusted individual if the patient cannot make decisions or needs a support person notified.

A patient who was registered yesterday returns today for a follow-up in the same episode of care. What should the PAR do regarding registration?

Answer: Verify and update demographic and insurance information, then link the visit to the existing encounter

Even for returning patients, demographics and insurance should be confirmed at each visit to capture any changes while linking the visit to the appropriate existing record.

Which of the following best describes 'medical necessity' in the context of patient registration and billing?

Answer: Services or items that are reasonable and necessary for the diagnosis or treatment of illness or injury

Medical necessity means the service is clinically appropriate, evidence-based, and required to diagnose or treat a patient's condition as defined by payer guidelines.