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Boot Camp
ARI Boot Camp
| Question | Answer |
|---|---|
| What is HIPAA? | Health Insurance Portability and Accountability Act |
| What function is patient inquiry? | 49 |
| What function is invoice inquiry? | 7 |
| Where can you do multi-invoice FSC transfer? | Function 6, Activity 101 |
| How can you transfer payments or FSCs? | Function 4, Activity O |
| How do you add or edit CSRS? | Function 92, Activity 1 |
| What function/action are for claims? | Function 30, Activity 7 |
| What function/action is dictionary? | Function 13, Activity 5 |
| What function/action do you use for refunds? | Function 4, Activity O |
| What function/action do you use to make shell invoice? | Function 2, Activity E |
| What function/action do you use to split an invoice? | Function 2, Actibity Z |
| What function/action are patient registration? | Function 1, Activity 1 |
| What does SHPS (Scripps Health Plan Services) do? | Provides managed care administrative services to SCMG, MPMG, and SCMC. |
| What license does SHPS have? | Limited Knox-Keene |
| What does Scripps Clinic Business Services do? | Billing and collections performed by Scripps Clinic Medical Group ONLY |
| What is the Menu Bar in Word? | Displays a list of commands - some with images next to them so you can quickly associate the command with the image. |
| What is the Standard Toolbar in Word? | A bar of icons that provides quick access to features of Word. |
| What are the 3 types of modeling tools in Excel? | Worksheets, Charts, and Lists |
| What are the 4 main types of an email? | Address, Subject, Message, Signature |
| How does a team player accept ownership of problems? | Accepts responsibility for solving problems, does not assign blame to others, does not make excuses, and does not present a problem to management without a proposed solution. |
| How does a team player act with integrity? | Is approachable, fair, non-judgemental, keeps promises, and does not engage in acts of retribution |
| How does a team player demonstrate accountability and reliability? | Willingly accepts job responsibilities, exhibits ownership of tasks, work consistently meets expectations |
| How does a team player communicate with others? | Respectfully, actively listens, remains calm, tone of voice and body language are positive |
| What is the Golden Rule of Assertive Behavior? | Be honest, courteous, and responsible |
| Listen __, Talk __. | 80%, 20% |
| What should apologies be? | Brief and to the point |
| What should you communicate in an apology? | Damage control |
| How do you deal with difficult people? | Just deal with them! |
| What is a root word? | The foundation of the word. |
| What does PMA stand for? | Patient Management Application |
| What does an HMO require from its plan members? | Requires plan members to obtain services from doctors and hosptials affiliated with the HMO. |
| What is the patient responsibility in HMOs? | Limited primarily to co-pays or non-covered services. |
| In an HMO, do members have to get authorizations? | Yes, to see a specialist or go out-of-network. |
| What is capitation? | Providers are paid a fixed per-capita (per-person) amount for each patient enrolled in the HMO over a certain period of time. CLAIMS ARE NOT SUBMITTED TO THE HEALTH PLAN. |
| What is Fee-For-Service (FFS)? | We charge a fee for the service provided, submit a claim, and receive payment based on the contracted rate. |
| What is an EPO? | Fee-for-service, but no out-of-network benefits. Services must be accessed through an in-network PMG. |
| What is an AOL? | Assumption of Liability form - must be signed for EPO |
| What is an IEF form? | Insurance Eligibility Form: states they understand the insurance information they provided is correct. |
| What is a PPO? | Preffered Provider Organization. |
| Do PPO members have to choose a PCP or PMG? | No, but patient responsibility is higher if they see a non-preffered provider. |
| What patient responsibilities apply to PPOs? | Deductible, copays and co-insurance. |
| What is a POS? | Point of Service Plan. Offers member different levels of cost sharing and coverages. |
| What is Tier 1 in a POS plan? | HMO - receives care through PCP or PMG |
| What is Tier 2 in a POS plan? | PPO - seeks treatment from any provider within the Preffered Provider Network |
| What is Tier 3 in a POS plan? | Indemnity - receive care from any provider outside the PMG or PPO |
| In what instances is a patient out-of-network? | They come to Scripps but have a different PMG. They are from another state. They want a second opinion. |
| What is a Commercial Insurance? | Any type of insurance we are not contracted with. Also called an indemnity plan. |
| What is TriCare? | The Dept. of Defense's worldwide healthcare program for active-duty and retired uniformed service members and their families. |
| Which TriCare plans do we accept? | Standard, For Life, and ChampVA. |
| What is Medicare? | Federal health insurance program for people 65 and older; certain younger people w/ disabilities; and people w/ end-stage renal disease. |
| What is Medicare Part A? | Coverage for acute inpatient hospitalization, skilled nursing care, hospice and home health care. |
| What is Medicare Part B? | Coverage for outpatient medical benefits. |
| What is Worker's Compensation? | No-fault system where injured workers receieve medical and compensation benefits, no matter who causes the accident. |
| What is Third Party Liability (TPL)? | When someone causes injury to another person either by act or omission. They become liable for the damages. SCRIPPS CLINIC DOES NOT DO THIRD PARTY BILLING. |
| What is Coordination of Benefits (COB)? | When the patient has two insurances, we wait until the primary pays, and then bill the secondary as a courtesy to the patient. |
| What is bundling/unbundling? | Unbundling: seperating units that might otherwise be packaged together. Bundling: putting together units that should be packaged seperate. THIS IS FRAUD. |
| What is the professional component? | All of the physician's work, including interpretation and report of the procedure. Also includes cost of education, malpractice insurance, and other expenses incidental to maintaining a practice. |
| What is the technical component? | The provision of equipment, supplies, technical personnel, and costs related to performance of a procedure other than the professional service. |
| What is global service? | The complete, 100% cost of a procedure (includes professional and technical component). |
| What is a CPT code? | Current Procedural Terminology. Describes medical, surgical, and diagnostic services. |
| What is an ICD-9 code? | A classification of diseases, injuries, causes of death and procedures. Also known as a Diagnosis Code. |
| Do we accept Medi-Cal? | No - only at physician's discretion or when it is secondary to Medicare. |
| Where would we send electronic OR manual claims to? | Commercial Insurance |
Created by:
mhillsd
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