Chapter 4
Patient Accounts and Data Flow
1. Define terms, phrases, abbreviations, and acronyms.
2. Discuss the variations in patient accounts and data flow for outpatient, ambulatory surgery, and inpatient services.
3. Outline the patient care process and provide an explanation of each phase.
4. Identify the tasks performed during the admission process and discuss forms used during the process.
5. Provide an explanation of the insurance verification process.
6. Discuss the purpose of medical record documentation and various forms and documents used in the medical record.
7. Provide an overview of patient care services provided by a hospital and explain how charges are captured for the services.
8. State the role of Health Information Management (HIM) in billing patient care services.
9. Discuss phases of the hospital billing process and how it relates to accounts receivable (A/R) management.
Admission Evaluation Protocols (AEP)
Advance Beneficiary Notice (ABN)
Charge Description Master (CDM)
HIPAA Notice of Privacy Practices
Hospital-Issued Notice of Non-Coverage (HINN)
Informed consent for treatment
Medication Administration Record (MAR)
Medicare Secondary Payer (MSP) Questionnaire
Quality Improvement Organization (QIO)
Patient Accounts and Data Flow
Patient Admission
Utilization Review (UR)
• Federal and state licensing requirements
• Participating provider agreements with various payers and government programs
• Peer review organizations, such as the QIO, have the authority to deny payment for services that do not meet stated requirements
• Services are medically necessary as defined in participating provider agreements.
• The level of service for provision of health care is appropriate according to the patient’s condition.
• Quality patient care services are provided in accordance with standards of medical care.