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RMA Admin
| Term | Definition |
|---|---|
| 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 |
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