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Review Chap. 1

QuestionAnswer
In an HMO with a gatekeeper system, who coordinates the patient's care and provides referrals? PCP
What combines a health plan that has a high deductible and low premiums with a special "savings account" that is used to pay medical bills before the deductible has been met? CDHP
Health plans pay for what services? Covered
In an HMO, securing ___________ may be required before services are provided. Preauthorization
A self-insured health plan may use its own? Funds
Unlike an HMO, a PPO permits its members to use _________ providers, but at a higher cost. Out-of-network
The major government-sponsored health programs are? TRICARE, CHAMPVA, Medicare, and Medicaid
Coinsurance is calculated based on? A percentage of a charge.
When a patient has insurance coverage for which the practice will create a claim, the patient bill is usually created when? After the encounter and after the payer's payment is posted.
If a patient's payment is later than permitted under the financial policy of the practice, the ______________ may be started Collection process
HMOs describe the following characteristics: Capitation, Restrict patients; choice of providers, Require preauthorization for services, Control drug costs, Control the use of services, Cost-sharing.
CDHPs describe the following characteristics: Similar to an individual retirement account (IRA), Use "savings account" to pay bills before deductible is met.
PPOs describe the following characteristics: Require preauthorization for services, Control the use of services, Cost-sharing, Most popular type of insurance plan, Create a network of physicians, hospitals, and other providers with whom they have negotiated discounts from the usual fees, Direct pati
Government-sponsored healthcare describe the following characteristics: It includes Medicare, Medicaid, TRICARE, and CHAMVA.
First step of the revenue cycle is? Preregister patients.
Second step of the revenue cycle is? Establish financial responsibility.
Third step of the revenue cycle is? Check in patients.
Fourth step of the revenue cycle is? Review coding compliance.
Fifth step of the revenue cycle is? Review billing compliance.
Sixth step of the revenue cycle is? Check out patients.
Seventh step of the revenue cycle is? Prepare and transmit claims.
Eighth step of the revenue cycle is? Monitor payer adjudication.
Ninth step of the revenue cycle is? Generate patient statements.
Tenth step of the revenue cycle is? Follow up payments and collections.
Medical assisting certification Can earn the title CMA or RMA.
Health information certification Can earn RHIA or RHIT certification; work in office-based physician practices, nursing homes, home health agencies, mental health facilities, and public health agencies.
Coding Certification Experts in classifying medical data; includes: CCA, CCS, CCS-P, CPC, and CPC-A certifications.
Continuing education Required by most professional organizations.
Communication Providing courteous and clear instructions to an elderly patient regarding his or her hospital bill.
Flexibility The ability to use archived paper record systems due to downtime in the electronic health record system to provide timely patient care information to providers.
Honesty and integrity Politely decline to discuss a patient's surgical outcome with cafeteria staff during lunch.
Ability to work as a team member Step in to assist front dest and reception staff during and overload at the customer service window in the waiting room,
Attention to detail Correctly file a patient's medical record
Created by: JuliFer25
 

 



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