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MED112 chapters 1
| Question | Answer |
|---|---|
| First Step of the revenue cycle | Preregister patients |
| Second Step of the revenue cycle | Establish financial responsibility |
| Third Step of the revenue cycle | Check in patients |
| Accounts receivable | Incoming money |
| Accounts Payable | Outgoing Expenses |
| Medical insurance | Written policy between the policy holder and health plan (Insurance company) |
| Benefits | Payments for medical services |
| Payer | (Insurance plan) |
| Third-Party | private or government organization paying for healthcare on behalf of the patient |
| health plan | (Insurance company) |
| First party | (provider) |
| Second party | patient |
| Schedule of benefits | List of what your insurance covers |
| Medical necessity | What they determine to be actually needed |
| Providers | Must meet payer professional standards |
| Covered Services | May include primary care, Emergency Care, Medical Specialists' Services, and surgery |
| Preventive medical services | Include physical examination pediatric, |
| Noncovered services | those not included in a plan's benefits |
| Excluded Services | Services that are not allowed coverage by the plan |
| Indemnity | All but Managed care. No restrictions |
| Premium | What's paid each months |
| Deductible | the amount the patient pays before the insurance pays |
| Out-Of-Pocket maximum | Max amount paid out in a year |
| Coinsurance | percentage paid by the insurer pay before insurance |
| Managed Care Organizations | MCO Health maintenance organizations • Point-of-service plans • Preferred provider organizations • Consumer-driven health plan |
| Health Maintenance Organization(HMO) | combines coverage of medical costs and delivery of healthcare for a prepaid premium |
| Point-Of-Service Plans (POS) | |
| Preferred Providers Organization (PPO) | MCO in which a network of providers supplies discounted treatment for plan members. |
| Consumer-Driven Health Plan (CDHP) | combines a high-deductible health plan with a medical savings plan. |
| Capitation | A fixed prepayment to a provider for all medically necessary contracted services provided to each plan member |
| Private Payers | dominated by large insurance companies. |
| Self-funded (self-insured) health plans | organizations paying for health insurance directly by setting up a fund from which to pay. |
| Government-sponsored healthcare programs | including Medicare, Medicaid, TRICARE, and CHAMPVA. |
| Private payers have contracts with | businesses to provide benefits for their employees and may also offer individual insurance coverage. |
| Most large employers that offer insurance have established themselves as self-funded (self-insured) health plans. | Self-funded health plans |
| Medical Coder | Medical office staff member with specialized training who handles the diagnostic and procedural coding of medical records |
| Fifth Step of the revenue cycle | Review billing compliance |
| Sixth Step of the revenue cycle | Check out patients |
| Seventh Step of the revenue cycle | Prepare and transmit claims |
| Eighth Step of the revenue cycle | Monitor payer adjudication |
| Ninth Step of the revenue Cycle | Generate patient statements |
| Tenth Step of the revenue Cycle | Follow up payments and collections |
| International Classification of Diseases, 10th Revision, Clinical Modification | ICD-10-CM |
| Diagnosis code | The number assigned to a diagnosis in the international classification of Diseases |
| ICD-10-CM for Alzheimer's Disease | G 30.9 |
| ICD-10-CM for Frostbite with tissue necrosis of the left wrist | T34.512A |
| Professionalism | is acting for the good of the public and the medical practice. |
| Ethics | standards of conduct based on moral principles |
| Etiquette | standards of professional behavior. |
| Certification | is the recognition of a superior level of skill by an official professional organization. |
| Medicare | Covers individuals who are age 65 and older, disabled, or have end-stage renal disease |
| Medicaid | Covers Low-Income people who cannot afford medical care |
| TRICARE | Covers medical expenses for active-duty or retired members of the uniformed services and their dependents |
| CHAMPVA | Covers Medical expenses for veterans with 100% service-related disabilities and their dependents |
| Forth Step of the revenue cycle | Review Coding Compliance |
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