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EHR link 4 ch 6 & 7
| Question | Answer |
|---|---|
| The person who bears ultimate financial responsibilty for a patient's account; usually is the patient, but this is for a minot or a person of decreased mental capacity may be a parent or gardian is called | guarantor |
| Unintentional deception in which a provider inappropriately bils for services that are not medically necessary, do not meet current standards of care, or are not medically sound is known as | abuse |
| Medical coding mistakes caused by computer error or by various kinds of human error, from simple carelessness to incorrect application of coding guidelines and procedures is known as | coding variance |
| A written set of office policies and procedures intended to ensure compliance with law regulating billing, coding, and third-party payers is known as | compliance plan |
| The standsrd claim form used by a non-institutional provider or supplier to bill medicare and most other insurance carriers for covered services is known as | CMS-1500 |
| A fixed, out-of-pocket expenfor covered services specified by the parient's healthcare plan and due at the time the service is rendered is known as | coypayment |
| A compreehensive set of medical codes and corresponding lablels that describes procedures, treatments, and services for the purpose of determining rembursment rates is called | CPT-4 |
| An info exchange techonoly that facilitates the rapid, accuret transfer of encrypted data in a standardized, mutually agreed upon format is known as | electronic data interchange (EDI) |
| EDI | electronic data interchange |
| A preprinted receipt given to the patient during each visit that lists the diagnosis and procedure codes most often used in the practice, along with info, account balance, and follow-up instructions is called an | encounter form |
| Presenting (or causing to be presented) claims for services that an individual or entity knows or should know to be false is known as | fraud |
| A coding system used to describe inpatient hospital diagnoses and procedures and hospital-based outpatient services and doctor office visits is called | ICD-9-CM |
| The procss of assigining standard numeric or alphanumeric codes to diagnoses, procedure, and treatment for reimbursment purposes is known as | medical coding |
| The unauthorized use of someone else's personal info to obtain medical services or submit fraudulent medical insurance claims for reimbursement is known as | medical identity theft |
| An outcomes-based payment model that offers providers financial incentives for meeting specific stansards and electronically documenting compliance with them; punitive measures may be applied to providers who fail to comply is called | pay for proformance (P4P) |
| An individual or entity other than the patient (the first payer) or the provider (the secondary party) that is financially responsible for a portion of the patient's healthcare bills is known as | third-party payer |
| A hight-weight ratio calculated by dividing the pateient's weight by the swuare of his hight is known as | body mass index (BMI) |
| BMI | body mass index |
| CDS | clinical decision support |
| A set of patient-centered tools embedded whithin EHR software that can be used to improve patient safety, ensure that care conforms to published protocol for specific conditions, and reduce duplicate or unnecessary care is known as | clinicla decision support (CDS) |
| A control value (a quantity or measurement) that serves as a benchmark against which later deviations (movement away from the baseline) can be compared is known as | baseline data |
| Disease that exist at the same time but are unrelated, such as arthritis and hypertension is called | comorbid conditions |
| The judicious application of current, valid, relevant scientific evidence to make healthcare decisions about individual patients is known as | evidence-based practice |
| The degree to which patients are able to stay informed about health and wellness and use this info to make well-considered dicisions about their own care id known as | health literacy |
| The use of health education, diagnostic screening, healthcare interventions, lifestyle modifications, and self-care to improve the quality of life and extend the life span is known as | health promotion |
| A legal doctrine that holsa that medical services rendered must be reasonable and necessary according to generally accepted clinical standards is known as | medical necessity |
| What starts with the scheduling of a patient and continues through the collection of the last payment for services rendered | revenue cycle management |
Created by:
maryce
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