Term | Definition |
implied contract | agreement based on actions |
bioethics issue | life and death |
informed consent | agreement to a surgical procedure and were explained the risks etc. |
advance directuve | power of attorney |
living will | DNR |
deformation of character | destruction of reputation |
respondent superior | liable for employees |
liquitor | breach of duty |
expressed contract | verbal or written contract |
standard of care | all physicians react and treat in the same way |
patients rights act | all patients have the right to privacy |
abandonment | physician cancels contract, must send certified letter |
good Samaritan law | protects from liability in a case of emergency |
EHR benefits | helps to avoid medical errors, cost saving, multi user access, digital x rays |
error in paper chart correction | use black ink, draw line, initial, write error |
caller should be on hold for... | 30 seconds |
phone answered by... | 3rd ring |
telephone triage | determines order to take calls |
arrive to office... | 30 minutes early |
medical record information is owned by.... | patient |
NPP | notice of privacy practice |
collating | collecting and gathering information |
active record | seen in the last 3 years |
inactive record | not seen in last 3 years |
closed record | terminated contract |
AMA recommends keeping records for.... | 10 years |
CPOE | computerized physicians order entry |
determination of which policy is primary and which one is secondary | coordination of benefits |
a fixed payment made at the time of service determined by insurance carrier | copayment |
10 digit number assigned to a provider | NPI |
obtaining permission for coverage from the patient's insurance carrier prior to a service being provided | preauthorization |
an amount of money that the insured must pay before the insurance begins to pay | deductible |
a uniform billing format for medical claims | cms 1500 |
determination of whether a patient is eligible for coverage of services | verification of benefits |
insurance coverage primarily for those over 65 | medicare |
belongs to a network of providers and arranges for specialists for the patient | primary care provider |
insurance coverage for low income | medicaid |
another name for an electronic transmission | EDI |
currently administers the medicare program | CMS |
name some supporting claim documentation | operative note, chart, laboratory report |
one of the reasons a claim may reject | timely filing |
part of medicare that covers hospital benefits | part A |
part of medicare that covers medications | part D |
medicare that covers physician visits | part b |
medicare that is managed care | part c |
covers injured workers | workers comp |
insurance coverage for retired military | TRICARE |
ABN | is a required form that needs to be a signed by a patient with medicare coverage if a procedure is not covered |
what are some patient's out of pocket expences | deductible, copay, coinsurance, premium, non covered services |
what is a physician fee schedule | a list of the amount charged for each service or procedure |
what is the difference of a primary/secondary payor | primary pays first and pays larger sum |
who is contacted to get preauthorizaton | insurance company |
who is contacted to get a managed care referral | pcp |
when does a MA verify | insurance information |
can providers charge different amounts to different insurance companies | NO |
the act of entering transactions into a patient accounting system | posting |
shows a reduction of fees or to correct a posting error | adjustment |
billing where statements are sent to a percentage of patients 3 or 4 times a month, steady cash flow | cycle billing |
a payment on an account does what to the A/R | decreases a/r balance |
how is the adjusted amount computed | original charge - allowed/approved amount |
if a patient makes a payment always give a | receipt |
accounts receivable is money owed by | patients or insurance companies |
if a patient come to the office for an office visit does it increase or decrease the A/R | increase |
if an insurance company reimbursed the 80% of the allowed amount of 65 then what happens? | an adjustment is made |
if a check was received from a patient or an insurance company a is made | deposit |
name 3 features of a practice management system | they have similar functions, they operate differently, each employee should have a user name and password, system records user entries, appt scheduling, patient registration, billing and claims processing |
name one reason an account error may be identified | patient reports a payment that is not theirs a patient reports a missing charge patient reports missing payment |
How many core functions should EHR be able to perform | 8 |
the system of medical procedure codes | CPT |
software tool used to document information by voice activation | speech recognition |
incentives for health care facilities and providers who use electronic health records | meaningful use |
Name the core functions of EHR | health information and data |
the drive to provide incentives to physicians and hospitals | HITECH |
health information controlled by the patient | PHR |
EHR systems can analyze the amount and type of data to determing | the correct E&M |
main provision of American Recovery and Reinvestment Act | HITECH |
what does SOAP stand for? | Subjective, objective, Assessment, Plan |
EHR can transfer codes in the patient management system as | pending charges |
what can EHR be accessed | computer workstations, laptop, tablet PC |
electronic method of using the medical record | EHR |
computerized system used to enter orders for labs, medications | CPOE |
act the protects all PHI stored electronically | HIPAA |
technology that enables the ability to send prescriptions electronically | e-prescribing |
a federal act that promotes adoption of EHR | HITECH |
a method of providing increased reimbursement to an office with EHR | incentives |
the process of recording information in EHR at the time of service | point of care |
sequence of events that begins once the patient makes an appointment | workflow |
in addition to the text stored in the medical record a code is also stored | coded data |
examples of stored EHR documents include xrays and ct scans | digital image system |
a process where rules can be set in the EHR so that the program does the monitoring of information, producing automatic reminders | alerts |
codes used for office visits | E&M |
codes used for diagnosis codes | ICD |
codes for procedure coding and DME | CPT and HCPCS |
what does the core function "health information and Data" include | diagnoses and medication lists |
What does HIPAA stand for | health insurance portability and accountability act |
ICD codes represents | the medical reason for the procedure |
Do medical offices receive incentives for e-prescribing? | yes |
paper documents can be scanned into the EHR using | digital image systems |
can the adoption of ehr improve patient care and assist in reimbursement for a procedure? | yes |
do facility's with ehr still have paper documents | yes |
the process of identifying a scanned image and tying it to the correct patient is called? | cataloging |
what are medical coders trained to do? | use the correct diagnosis and procedure coding |
when the code is stored with the record in addition to the text it is considered? | codified |
What requires the use of ICD, CPT and HCPCS codes | HIPAA |
work flow begins... | when patient makes appointment |
adjustment | change to balance that does not involve an exchange of money |
accounts recievable | total amount of money owed to office from patients and insurances |
collection call rules | dont call before 8 or after 9, no holiday calls or sunday calls |
ICD | international classification of diseases |
diagnosis codes are the... | reason for services, basis for reimbursemement |
compliance | follow rules |
fraud | knowingly bill for services for a higher reimbursement |
abuse | improper billing, not intentional |
tabular list | numerical list of encounters, used to verify |
conventions | how something is typically done |
code also | more than one code to describe |
see also | code references another main term |
additional references for specialized purposes: | neoplasms, abnormalities, drugs & chemicals, external causes |
abstracting | information found in patient record |
CPT | current procedural term |
HIPAA | health insurance portability and accountability act, mandates cpt and icd codes must be used |
E&M | codes for physician encounters |
audit | verify info |
global period | number of days around a procedure, pre op and post ob |
HCPCS | health care common procedure coding system, durable equipment codes |
EDI | codified date, electronic data interchange |
Medicare | for over 65, disabled, end stage renal disease, |
Medicare Part A | hospital |
Medicare Part B | physician |
Medicare Part C | managed care |
Medicare Part D | prescriptions |
tricare | active duty and retired personelle and families |
champva | veterns with service disabilities |
CMS | center for medicare and caid services |
ABN | advanced beneficiary notice waiver |
physician fee schedule | list of charges for all services |
NPI | national provider identifier, 10 digit |
deductible | before insurance pays benefits |
CMS 1500 | billing format for medical claims |
verification of benefits | determining eligibility |
PCP | primary care provider |
non covered services | not eligible for reimbursement |
coinsurance | fixed % of charges patient pays |
premium | monthly bill for next months coverage |