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MCA 100

Ch 1 questions

list ten steps of medical billing process 1.preregister pt 2.establish $ responsability 3.chek in pt 4.review coding complience 5.review billing compliance 6.check out pt 7.prepare & transmit claims 8.monitor payer adjudication 9.generate patient statments 10. follow up payments & collections
what does ICD-9(or10)-CM stand for? international classification of diseases (9th or 10th revision)-Clinical modification.
how are ICD-9&10-CM used? they are used to code a diagnosis so that they can be sent and reviewed for payment by insurance companies
what does CPT stand for? current procedural technology
When is CPT used? used to report medical procedures and services.
what is the purpose of coding? allows info to be used between drs, office personell health plans and so on without losing the precise meaning
what is a diagnosis? the Drs opinion on the nature of the ilness or injury of the pt
what are procedures? services performed
what are the advantages of EHR? makes reporting easier 4 studies, past and present pt info dr uses to diagnos and treat. helps dr make informed decision. ability to order tests and meds. decision support. communication between DR.// Continuity of care.
whats the difference between EHR, EMR, PHR? EHR is a whole life record, EMR is for 1 pt/1dr, PHR is a record the pt creates, maintains, and owns.
whats is a pmp? Practice management programs, software that automates admin task
what information is found on a PT information sheet personal, employment, and medical insurance data
what is an encounter form and what info does it contain? its a form containing what was done during the visit
what is a clearinghouse? its a party between dr office and insurance that reviews claims before insurance companies receive claims.
describe RAs and EOBs and tell the difference remittance advice is provided directly to the health-care provider, whereas the explanation of benefits statement is sent to insured patient.
what does HIPAA stand for and what does it accomplish? health insurance portability and accountabiliy act, ensures privacy and security of health info
what is PHI? protected health info used to identify pts
what are the 3 security standards under the HIPAA Security Rule? PHI is created, received, maintained or transmitted across a network
Define HITECH Health Information Technology for Economic and Clinical Health Act encourages clinics to use technology for healthcare through reimbersments
What is meaningful use and what are the incentives to DR for its implementation? they get money if they ACUTUALLY use the electronic system
what is ACA? affordable care act increases health care improves quality and explores new models for delivery and payment
whats is PCMH and what are the core features? Patient-Centered Medical Home; quality safety and efficiency
what is the benefit of monitoring claim status? to ensure timely payment
what are the core functions of EHRs? health info & data elements, results mgmt, order mgmt, decision support, communication and connectivity, pt support, admin process, reporting population health.
what is needed for an insurance company to make payment on a claim? info about pt, procedures, diagnosis, date and location
what are advantages of EHRs? safety quality and efficiency
Define HIE health info exchange is the use of a network to exchange information between drs
Define electronic prescribing the use of computers or hand held devices to place prescription order
refine RECs reginal extension centers, help line to train and prepare clinics to adopt EHR
Created by: a.stonela89