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Medisoft
Medisoft Final exam study guide
| Question | Answer |
|---|---|
| A paper document from a health plan that lists the amount of a benefit and explains how it was determined | explaination of benefits (EOB) |
| a document that contains personal, employment, and medical insurance information about a patient | patient information form |
| a form listing procedures relevant to the specialty of a medical office, used to record the procedures | encounter form |
| private or government organization that insures or pays for health care | payer |
| an electronic document from a health plan that lists the amount of a benefit and explains how it was determined | remittance advice (RA) |
| A small fixed fee paid by the patient at the time of an office visit | copayment |
| an indicidual who has contracted with a health plan for coverage | policyholder |
| a payment made to a health plan by a policyholder for coverage | premium |
| a fixed amount that is paid to a provider in advance to provide medically necessary services to patients | capitation |
| A type of insurance in which the carrier is responsible for the financing and delivery of health care | managed care |
| a term used to describe money coming in to a business | accounts receivable (AR) |
| a type of managed care system in which providers are paid fixed rates at regular intervals | health maintance organization (HMO) |
| an insurance plan in which policyholders are reimbursed for health care costs | fee-for-service |
| under an insurance plan, the portion or percentage of the charges that the patient is responsible for paying | coinsurance |
| a network of health care providers who agree to provide services to plan members at a discounted fee | preferred provider organization (PPO) |
| a value that stands for a patient's illness, signs, or symptoms | diagnosis code |
| a number that represents medical procedures performed by a provider | procedure code |
| the flow of financial transactions in a business | accounting cycle |
| a plan, program, or organization that provides health benefits | health plan |
| an organization that receives claims from a providers, checks and prepares them for processing, and transmits them to insurance carriers in a standardized format | clearinghouse |
| a national standard indentifier for all health care providers consisting of ten numbers | national provider indentifier (NPI) |
| a software program that automates many of the administrative and financial tasks required to run a medical practice | practice management program (PMP) |
| regulations outlining the minimum safeguards required to prevent unauthorized access to electronic health care information | HIPPA Security Rule |
| a document listing charges and payments that is given to a patient after an office visit | walkout statement |
| the electronic format of the claim used by physician's offices to bill for service | X12-837 Health care claim (837P) |
| a copy of data files made at a specific point in time that can be used to restore data to the system | backup data |
| collection of related pieces of information | database |
| the process of deleting files of patients who are no longer seen b a provider in a practice | purging data |
| Physician's notes about a patient's condition and diagnosis | record of treatment and progress |
| a physician who recomments that a patient make an appointment with a particular doctor | referring physician |
| an insurance plan in which payments are made to primary care providers whether patients visit the office or not | capitated plan |
| Changes to patient's accounts | adjustments |
| the amounts billed by a provider for particular services | charges |
| monies paid to a medical practice by patient and insurance carriers | payments |
| payments made to physicians on a regularbasis for providing services to patients in a managed care insurance plan | capitation payments |
| type of billing in whcih patients are divided into groups and statement printing and mailing is staggered throughout the month | cycle billing |
| a document that specifies the amount the provider will be paid for each procedure | fee schedule |
| statement that shows all charges regardless of whether the insurance has paid on the transactions | standard statements |
| legislation that mandates a time period within which clean claims must be paid; if they are not, financial penalties are levied against the payer | prompt payment laws |
| an account that does not respond to collection efforts and is written off the practice's expected accountss receivable | uncollectible account |
Created by:
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