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Medical office questions and answers
|The flow of financial transactions in a business is a
|Money that flows into a business
|The schedule of sending statements to patients is a
|a form of translating a description of a condition into a shorter, standardized code is
|A series of steps that determine whether a claim should be paid
|part of charges that an insured person must pay for health care services after payment of the deductible amount
|advance payment to a provider that covers each plan member's health care services for a certain period of time
|a small fixed fee paid by the patient at the time of an office visit
|list of procedures and charges for a patient's visit
|type of managed care in which a high-deductible/low-premium insurance plan is combined with a pretax savings account to cover out-of-pocket medical expenses, up to the deductible limit
|consumer-driven health plan (CDHP)
|physician's opinion of the nature of the patient's illness or injury
|standardized value that represents a patient's illness, signs, and symptoms
|document from a payer that shows how the amount of a benefit was determined
|Explanation of Benefits (EOB)
|a managed health care system in which providers agree to offer health care to the organization's members for fixed periodic payments from the plan
|Health Maintenance Organization (HMO)
|type of insurance where the carrier is responsible for both the financing and the delivery of health care
|A health plan that repays the policyholder for covered medical expenses
|a plan, program, or organization that provides health benefits
|treatment provided by a physician to a patient for the purpose fo preventing, diagnosing, or treating an illness, injury, or its symptoms in a manner that is appropriate and provided in accordance with generally accepted standards of medical practice
|form that includes a patient's personal, employment, and insurance data needed to complete an insurance claim
|patient information form
|a person who analyzes and codes patient diagnoses, procedures, and symptoms
|person who buys an insurance plan - the insured
|managed care network of providers that agree to perform services for plan members at discounted fees
|Preferred Provider Organization (PPO)
|private or government organization that insures or pays for health care on the behalf of the beneficiaries
|software program that automates many of the administrative and financial tasks required to run a medical practice
|practice management program (PMP)
|a code that identifies a medical service
|medical treatment provided by a physician or other health care provider
|a list of services performed, and charges
|an EOB transmitted electronically by a payer to a provider
|remittance advice (RA)
|the periodic amount of money the insured pays to a health plan for insurance coverage
|What is PHI?
|Protected Health Information
|What is TPO?
|treatment, payment, and healthcare operations
|What is a number that the insurance issues to a specialist, admitting hospital or for a particular procedure
|preauthorization or certification number
|What guidelines ensure when a patient has more than one policy, maximum appropriate benefits are paid but, not duplications?
|coordination of benefits (COB)
|What is this an example of: When a child is covered by more than one policy it helps to decide which one is the primary coverage by using the parents birthday.
|Who gets a walk out receipt or walkout statement?
|anyone that made a payment during the visit
|Why would a practice not want to accept a debit or credit?
|they require a processing fee
|What is PPO?
|Preferred Provider Organization
|What is HMO?
|Health Maintenance Organization
|What are these examples of: Indemnity, Managed Care, HMO, and PPO
|health care plans
|a report that lists errors in a claim
|What is the information about a patient's past, present, or future physical or mental health or payment for health care that can be used to identify the person?
|Protected Health Information (PHI)
|What is an organization that receives claims from a provider - checks, and prepares them for processing - transmits them to insurance carriers in a standardized format?
|What is the use of computers & handheld devices to write & transmit prescriptions to a pharmacy?
|electronic prescribing (e-prescribing)
|what is the transfer of a business transaction from one computer to another using communication protocols?
|electronic data interchange (EDI)
|national standard identifier for all health care providers, whcih consists of 10 #s
|national provider identifier (NPI)
|What is Information Technology (IT)?
|computer hardware and software system
|What is the electronic format of the claim used by a physicians office to bill for services?
|X12-837 Health Care Claim (837P)
|What regulations require electronic transactions to use standardized formats?
|HIPPA electronic transaction & code sets standards
|regulation guidelines that identify the safeguards required to prevent unauthorized access to electronic health care information
|HIPPA security rule
|What is the section of an EOB that identifies who was paid, how much, and when?
|benefit payment information
|The deductible under many plans applies to each individual each
|If noncovered services are provided, who is responsible for 100% of the costs.
|The section of an EOB that identifies the total deduction, noncovered charges, and balance the patient may owe is the
|A provider that is able to balance-bill a patient for the amount over the allowed charge is referred to as a
|If a claim is found to not be medically necessary at the level reported, the claim will be
|If an a claim is downcoded, the medical office assistant should
|appeal to the insurance carrier
|If the appeal is denied, the medical office assistant can complain to the
|state insurance commissioner
|The submission of additional clinical information to a insurer to overturn a claim denial is known as an
|Medicare Part B says the main reason for returning an appeal is due to the lack of a
|If a service is not documented in the medical record...
|it didn't happen
|What is SOAP?
|subjective, objective, assesment plan
|Concerning SOAP, information the patient shares with the doc, is considered to be
|Concerning SOAP, the E/M history is considered
|When an objective, unbiased group of physicians determines what payment is adequate for services provided, the process is called
|Many _____ _____ may see re-billing as a duplicate claim, fraudulent billing, and a notice that payment is delinquent.
|What if some services on a claim were over looked by the provider's office; or if charges on the orginal claim were not detailed; or if the medical office specialist made a mistake on the claim? Would these be reasons to re-bill?
|An examination and verification of claims submitted by a physician is an
|How do you make sure you have all info from the insurance card?
|copy both sides
|What do you need from the insurance card?
|Customer service number #, ID # or policy #, Group #, Co-pay, Co-insurance & Admission certification
|If an adult has there own policy, plus they are a dependent on another policy, which policy is their primay or secondary?
|the policy that names them as the policyholder is the primary policy
|What are the written or dicated notations of an encounter between a provider and an individual - may be called medical notes or provider's notes.
|What is the encounter form that is preprinted with the ICD-9-CM and CPT codes that are most frequently used in that office? (may be called free ticket or routing slip)
|Confriming that the services will be covered by the patient's plan is
|Contacting the insurer to verify an active policy is
|The #'s or letters that connect an individual to a specific insurance policy is the
|policy number or ID number
|#'s or letters that connect the patient to an individual policy with a specfic group of other insureds is a
|group name or number
|A individual that obtains an insurance policy is a ____. (may be called insured)
|The policy which identifies the patient as the policyholder or the insured party is the
|primary Insurance policy