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RMA Admin

TermDefinition
implied contract agreement based on actions
bioethics issue life and death
informed consent agreement to a surgical procedure and were explained the risks etc.
advance directuve power of attorney
living will DNR
deformation of character destruction of reputation
respondent superior liable for employees
liquitor breach of duty
expressed contract verbal or written contract
standard of care all physicians react and treat in the same way
patients rights act all patients have the right to privacy
abandonment physician cancels contract, must send certified letter
good Samaritan law protects from liability in a case of emergency
EHR benefits helps to avoid medical errors, cost saving, multi user access, digital x rays
error in paper chart correction use black ink, draw line, initial, write error
caller should be on hold for... 30 seconds
phone answered by... 3rd ring
telephone triage determines order to take calls
arrive to office... 30 minutes early
medical record information is owned by.... patient
NPP notice of privacy practice
collating collecting and gathering information
active record seen in the last 3 years
inactive record not seen in last 3 years
closed record terminated contract
AMA recommends keeping records for.... 10 years
CPOE computerized physicians order entry
determination of which policy is primary and which one is secondary coordination of benefits
a fixed payment made at the time of service determined by insurance carrier copayment
10 digit number assigned to a provider NPI
obtaining permission for coverage from the patient's insurance carrier prior to a service being provided preauthorization
an amount of money that the insured must pay before the insurance begins to pay deductible
a uniform billing format for medical claims cms 1500
determination of whether a patient is eligible for coverage of services verification of benefits
insurance coverage primarily for those over 65 medicare
belongs to a network of providers and arranges for specialists for the patient primary care provider
insurance coverage for low income medicaid
another name for an electronic transmission EDI
currently administers the medicare program CMS
name some supporting claim documentation operative note, chart, laboratory report
one of the reasons a claim may reject timely filing
part of medicare that covers hospital benefits part A
part of medicare that covers medications part D
medicare that covers physician visits part b
medicare that is managed care part c
covers injured workers workers comp
insurance coverage for retired military TRICARE
ABN is a required form that needs to be a signed by a patient with medicare coverage if a procedure is not covered
what are some patient's out of pocket expences deductible, copay, coinsurance, premium, non covered services
what is a physician fee schedule a list of the amount charged for each service or procedure
what is the difference of a primary/secondary payor primary pays first and pays larger sum
who is contacted to get preauthorizaton insurance company
who is contacted to get a managed care referral pcp
when does a MA verify insurance information
can providers charge different amounts to different insurance companies NO
the act of entering transactions into a patient accounting system posting
shows a reduction of fees or to correct a posting error adjustment
billing where statements are sent to a percentage of patients 3 or 4 times a month, steady cash flow cycle billing
a payment on an account does what to the A/R decreases a/r balance
how is the adjusted amount computed original charge - allowed/approved amount
if a patient makes a payment always give a receipt
accounts receivable is money owed by patients or insurance companies
if a patient come to the office for an office visit does it increase or decrease the A/R increase
if an insurance company reimbursed the 80% of the allowed amount of 65 then what happens? an adjustment is made
if a check was received from a patient or an insurance company a is made deposit
name 3 features of a practice management system they have similar functions, they operate differently, each employee should have a user name and password, system records user entries, appt scheduling, patient registration, billing and claims processing
name one reason an account error may be identified patient reports a payment that is not theirs a patient reports a missing charge patient reports missing payment
How many core functions should EHR be able to perform 8
the system of medical procedure codes CPT
software tool used to document information by voice activation speech recognition
incentives for health care facilities and providers who use electronic health records meaningful use
Name the core functions of EHR health information and data
the drive to provide incentives to physicians and hospitals HITECH
health information controlled by the patient PHR
EHR systems can analyze the amount and type of data to determing the correct E&M
main provision of American Recovery and Reinvestment Act HITECH
what does SOAP stand for? Subjective, objective, Assessment, Plan
EHR can transfer codes in the patient management system as pending charges
what can EHR be accessed computer workstations, laptop, tablet PC
electronic method of using the medical record EHR
computerized system used to enter orders for labs, medications CPOE
act the protects all PHI stored electronically HIPAA
technology that enables the ability to send prescriptions electronically e-prescribing
a federal act that promotes adoption of EHR HITECH
a method of providing increased reimbursement to an office with EHR incentives
the process of recording information in EHR at the time of service point of care
sequence of events that begins once the patient makes an appointment workflow
in addition to the text stored in the medical record a code is also stored coded data
examples of stored EHR documents include xrays and ct scans digital image system
a process where rules can be set in the EHR so that the program does the monitoring of information, producing automatic reminders alerts
codes used for office visits E&M
codes used for diagnosis codes ICD
codes for procedure coding and DME CPT and HCPCS
what does the core function "health information and Data" include diagnoses and medication lists
What does HIPAA stand for health insurance portability and accountability act
ICD codes represents the medical reason for the procedure
Do medical offices receive incentives for e-prescribing? yes
paper documents can be scanned into the EHR using digital image systems
can the adoption of ehr improve patient care and assist in reimbursement for a procedure? yes
do facility's with ehr still have paper documents yes
the process of identifying a scanned image and tying it to the correct patient is called? cataloging
what are medical coders trained to do? use the correct diagnosis and procedure coding
when the code is stored with the record in addition to the text it is considered? codified
What requires the use of ICD, CPT and HCPCS codes HIPAA
work flow begins... when patient makes appointment
adjustment change to balance that does not involve an exchange of money
accounts recievable total amount of money owed to office from patients and insurances
collection call rules dont call before 8 or after 9, no holiday calls or sunday calls
ICD international classification of diseases
diagnosis codes are the... reason for services, basis for reimbursemement
compliance follow rules
fraud knowingly bill for services for a higher reimbursement
abuse improper billing, not intentional
tabular list numerical list of encounters, used to verify
conventions how something is typically done
code also more than one code to describe
see also code references another main term
additional references for specialized purposes: neoplasms, abnormalities, drugs & chemicals, external causes
abstracting information found in patient record
CPT current procedural term
HIPAA health insurance portability and accountability act, mandates cpt and icd codes must be used
E&M codes for physician encounters
audit verify info
global period number of days around a procedure, pre op and post ob
HCPCS health care common procedure coding system, durable equipment codes
EDI codified date, electronic data interchange
Medicare for over 65, disabled, end stage renal disease,
Medicare Part A hospital
Medicare Part B physician
Medicare Part C managed care
Medicare Part D prescriptions
tricare active duty and retired personelle and families
champva veterns with service disabilities
CMS center for medicare and caid services
ABN advanced beneficiary notice waiver
physician fee schedule list of charges for all services
NPI national provider identifier, 10 digit
deductible before insurance pays benefits
CMS 1500 billing format for medical claims
verification of benefits determining eligibility
PCP primary care provider
non covered services not eligible for reimbursement
coinsurance fixed % of charges patient pays
premium monthly bill for next months coverage
Created by: court811