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Medical specialist

Chp 2/3

Which forms need patient signatures that also need to be obtained 1-Release of medical information 2-Assignment of benefits 3-Acknowledgement of privacy practices 4- Financial agreement
What is the Birthday Law? whose ever Birthday falls first (day and month) in the calender year is the primary payer and the other person insured covering the dependents becomes the secondary payer.
What is the minimum info that should be on a claim form? -What was done CPT(procedures done)-Why it was done ICD9(diagnosis)-When it was done Date of service-Where it was performed(POS)-Who did it provider and NPI
What tasks does the receptionist have? 1.Collect patient registration form 2. Obtain insurance requirements 3.Copy Insurance card 4-Attach encounter form to patient record
What task(s) does the Physician/Medical assistant have? 1.Marks services/procedures and diagnosis on encounter form
What tasks does the Insurance specialist have? 1.Code diagnosis and procedures not on the encounter form from patient record 2.Complete Insurance claim form 3.Copy form for insurance pending file 4.Mail form to insurance carrier
What is an adjustment? A courtesy or write off
How is an EOB(explanation of benefits) filed away? Filed away by date posted.
What is an Encounter form? An all encompassing Billing form
Basic Health covers what? Covers benefits for hospitals,surgical,and other medical expenses.
What does major medical cover? Contracts are set up to offset large medical expenses in the hospital.There is no physician coverage in office.
What is Precertification? When you call to find out if treatment is covered under a patients contract.
What is Preauthorization? Is not only finding out whether something is covered but also to find out if the service medically necessary.
What is Predetermination? finding out the maximum dollar amount that the insurance will pay.Usually done when reimbursement is not known or for expensive procedures.
What is Remittance Advice? the term used by medicare and medicaid programs to describe services billed how payment was determined.
Define waiting period? Some policies may have period of time where is not in effect or that certain diagnosis may not be covered.It could be up to a year in some instances depending on the policy.
Assignment of Benefits? A very important document that is signed by the patient to insure that payment goes directly from the insurance company to the physician.
What is Workers comp? A contract purchased by the employer that insures the employee against on the job injury or illness.
What is unemployment compensation disability? Covers Off the job injury or sickness that is paid by deductions from a persons paycheck.(ex. AFLAC)
what is TRICARE? a government sponsored program that provides hospital and medical services for dependents of active service personnel or retired service personnel
What is CHAMPVA? A federal program that covers medical expenses of spouses and children of veterans with total,permanent service connect disabilities or death.
What is the reimbursement cycle? The process from start to finish used to collect money in the physicians office.
Define Accounts receivable (A/R)? The total amount of money owed for the services minus all payments is the accounts receivable.
What is The patient registration form? A questionnaire designed to collect demographic data and essential facts about the medical insurance coverage for each patient seen for professional services.(a.k.a patient info form)
What is a day sheet? A register for recording daily business transactions(charges,payments,or adjustments)
What is the difference between an implied and an expressed contract when dealing with a patient and physician? A Implied can be verbal/assumed its deduced from the circumstances.Expressed is a verbal or written contract.
List the % types of policy renewal provisions. 1. cancelled grants 2. optionally renewable 3.Conditionally Renewable 4. Guaranteed renewal 5.Noncancelable policy
Define Coinsurance Costsharing requirement which means the insured will assume a percentage of the cost.
What are the 3 ways to obtain health insurance? 1.Group-obtained through employer 2.Individual- obtained through self for self 3-Prepay plan-paying yearly or fixed periodic payments in return for insurance benefits.
What is the criteria for an emancipated minor? -younger than 18-lives independently-totally self supporting-married or divorced-parent-in military-college students living away from home
In employment and disability exams who does the contract exist between? The insurance company requests the exam therefore the contract lies between the insurance company and the physician.
What is Coordination of benefits? The combo of payments from the primary and secondary carrier cannot be more than the amount of the providers charge.
Define Medicaid Program sponsored jointly by federal,state and local governments to provide healthcare to indigent persons on welfare,aged individuals,and the disabled.
Created by: Brittnilemm
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