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MOM Ch 13
Side A
| answer | question |
|---|---|
| OBRA (Omnibus Budget Reconciliation Act) | legislation passed by ongress in 1993 to calculate healthcare service fees by formula |
| fee schedule | list of services and their fees |
| national standard | point of reference for developing charges for healthcare services used throughout the United States |
| GPCI (Geographical Practice Cost Index) | Medicare system of adjusting fees based on the county in which the healthcare provider practices |
| RVU (Relative Value Unit) | numeric value assigned by Medicare to formulate fee schedules for healthcare providers |
| national conversion factor | number released by Medicare each year that determines fee schedules for all healthcare services |
| TN – 6 years; VA – 5 years | Statutes of limitations for collecting a healthcare debt |
| red flag rule | when offices doesn't collect co-pays; legislation to reduce fraud and identity theft; applies to any business or entity that extends credit; requires the medical office to have a written program in place to verify patient identity, before extending credit |
| accounts receivable (AR) | money owed the medical practice |
| aging report | documentation of the money owed the medical office and how long accounts have been outstanding; OUTSTANDING ACCOUNTS; CHECK WEEKLY |
| verify the patient's identity, tell the patient the reason for the call, document any promises the patient makes, call the Patient between 8am and 9 pm | Dos for collection telephone calls |
| call the patient if the patient asks not to be called, become angry if the emotion arises, make promises that cannot be kept, neglect to document all parts of the conversation with the patient | Don'ts for collection telephone calls |
| Insurance fraud | illegal act by a healthcare provider involving an insurance company |
| hardship agreement | agreement a patient signs to indicate an inability to pay full healthcare costs due to financial hardship |
| professional courtesy | a discount offered to friends, colleagues, and family members of the physician |
| patient billing statement | monthly statement sent to patients who have outstanding balances; COPY CHECKS OF PAYMENTS & SEND IT TO PATIENT; PUT A COPY IN PATIENT FILE |
| security envelope | in order to be HIPAA compliant, patient billing statements must be sent in a |
| certified letter | postal service letter that the recipient must sign for |
| tickler file | tool for tracking future events, such as patient appointments |
| collection agencies | company that pursues overdue accounts for a fee |
| Fair Debt Collection Practices Act | law that dictates how debts may be collected |
| write off | to remove a balance from a patient account |
| uncollectible account | account that will likely never be paid |
| Chapter 7 | all nonexempt patient assets are sold and the proceeds distributed to creditors |
| Chapter 9 | used for town reorganizations; does not apply to medical bills |
| Chapter 11 | used for business reorganizations; does not apply to medical bills |
| Chapter 12 | used by farmers who cannot meet their financial obligations; does not apply to medical bills |
| Chapter 13 | protects debtors from creditors while the debtors arrange to repay all or some of their debts over 3- to 5-year periods |
| community property laws | legislation that deems one spouse financially responsible for the other spouse's debts |
| face to face | best way to collect |
| ID | verifying patient's |
| send a letter | forgiveness |
| cash, check, debit card, credit card | types of payments |
| explanation of benefits | EOB |
Created by:
Stacey_Gantt5
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