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Health Insurance - 1

ACI - Medical Billing and Coding

QuestionAnswer
Money leftover Profit
Medical Record Legal document of patient assessment
1st Party Patient
2n Party Provider
3rd Parth Health Insurance Co.
Name the two types of health insurance Government and Private
Define each letter of S.O.A.P. S - Subjective, O - Objective, A - Assessment, P - Plan of treatment
In S.O.A.P., give a brief description of "S" "S" is subjective data, data that is not measurable such as "I have a bad cough", "I am in a lot of pain."
In S.O.A.P., give a brief description of "O" "O" is objective data, data that is measurable such as a blood pressure, temperature, etc. reading. Pain expressed as a number from 1-10.
In S.O.A.P., give a brief description of "A" "A" is the healthcare provider's assessment of the patient such as hypertension, sprain.
In S.O.A.P., give a brief description of "P" "P" is the plan of treatment that the healthcare provider has set for the patient.
What is E.O.B.? Explanation of benefits
What is E.O.M.B.? Explanation of medical benefits
Define clean claim
Define clearinghouse.
Define prior authorization
Define referral
Give a brief explanation of the "birthday rule." When a husband, wife have a child and then divorce the child is carried on the policy of the parent whose birthday comes first in the calendar year.
Give an example of how the "birthday rule" is applied. Dad's birthday is Jan. 2, 1963, Mom's birthday is May 3, 1962. Mom is older but Dad's birthday (Jan.) comes first in the calendar year.
Created by: laholbein