Boot Camp

Description:	ARI Boot Camp
Category:	Clinical Skills
Created by:	mhillsd on 2009-02-27

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