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Medical specialist
Chp 2/3
| Question | Answer |
|---|---|
| Which forms need patient signatures that also need to be obtained | 1-Release of medical information 2-Assignment of benefits 3-Acknowledgement of privacy practices 4- Financial agreement |
| What is the Birthday Law? | whose ever Birthday falls first (day and month) in the calender year is the primary payer and the other person insured covering the dependents becomes the secondary payer. |
| What is the minimum info that should be on a claim form? | -What was done CPT(procedures done)-Why it was done ICD9(diagnosis)-When it was done Date of service-Where it was performed(POS)-Who did it provider and NPI |
| What tasks does the receptionist have? | 1.Collect patient registration form 2. Obtain insurance requirements 3.Copy Insurance card 4-Attach encounter form to patient record |
| What task(s) does the Physician/Medical assistant have? | 1.Marks services/procedures and diagnosis on encounter form |
| What tasks does the Insurance specialist have? | 1.Code diagnosis and procedures not on the encounter form from patient record 2.Complete Insurance claim form 3.Copy form for insurance pending file 4.Mail form to insurance carrier |
| What is an adjustment? | A courtesy or write off |
| How is an EOB(explanation of benefits) filed away? | Filed away by date posted. |
| What is an Encounter form? | An all encompassing Billing form |
| Basic Health covers what? | Covers benefits for hospitals,surgical,and other medical expenses. |
| What does major medical cover? | Contracts are set up to offset large medical expenses in the hospital.There is no physician coverage in office. |
| What is Precertification? | When you call to find out if treatment is covered under a patients contract. |
| What is Preauthorization? | Is not only finding out whether something is covered but also to find out if the service medically necessary. |
| What is Predetermination? | finding out the maximum dollar amount that the insurance will pay.Usually done when reimbursement is not known or for expensive procedures. |
| What is Remittance Advice? | the term used by medicare and medicaid programs to describe services billed how payment was determined. |
| Define waiting period? | Some policies may have period of time where is not in effect or that certain diagnosis may not be covered.It could be up to a year in some instances depending on the policy. |
| Assignment of Benefits? | A very important document that is signed by the patient to insure that payment goes directly from the insurance company to the physician. |
| What is Workers comp? | A contract purchased by the employer that insures the employee against on the job injury or illness. |
| What is unemployment compensation disability? | Covers Off the job injury or sickness that is paid by deductions from a persons paycheck.(ex. AFLAC) |
| what is TRICARE? | a government sponsored program that provides hospital and medical services for dependents of active service personnel or retired service personnel |
| What is CHAMPVA? | A federal program that covers medical expenses of spouses and children of veterans with total,permanent service connect disabilities or death. |
| What is the reimbursement cycle? | The process from start to finish used to collect money in the physicians office. |
| Define Accounts receivable (A/R)? | The total amount of money owed for the services minus all payments is the accounts receivable. |
| What is The patient registration form? | A questionnaire designed to collect demographic data and essential facts about the medical insurance coverage for each patient seen for professional services.(a.k.a patient info form) |
| What is a day sheet? | A register for recording daily business transactions(charges,payments,or adjustments) |
| What is the difference between an implied and an expressed contract when dealing with a patient and physician? | A Implied can be verbal/assumed its deduced from the circumstances.Expressed is a verbal or written contract. |
| List the % types of policy renewal provisions. | 1. cancelled grants 2. optionally renewable 3.Conditionally Renewable 4. Guaranteed renewal 5.Noncancelable policy |
| Define Coinsurance | Costsharing requirement which means the insured will assume a percentage of the cost. |
| What are the 3 ways to obtain health insurance? | 1.Group-obtained through employer 2.Individual- obtained through self for self 3-Prepay plan-paying yearly or fixed periodic payments in return for insurance benefits. |
| What is the criteria for an emancipated minor? | -younger than 18-lives independently-totally self supporting-married or divorced-parent-in military-college students living away from home |
| In employment and disability exams who does the contract exist between? | The insurance company requests the exam therefore the contract lies between the insurance company and the physician. |
| What is Coordination of benefits? | The combo of payments from the primary and secondary carrier cannot be more than the amount of the providers charge. |
| Define Medicaid | Program sponsored jointly by federal,state and local governments to provide healthcare to indigent persons on welfare,aged individuals,and the disabled. |
Created by:
Brittnilemm
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