Administrative Office Procedures
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show | Patients are scheduled at the same time each hour to create short-term flexibility each hour. Schedule 2 or 3 patients during a designated hourly time period.
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show | Wave booking can be modified in a couple of different way. One example of this approach is to schedule 2 patients to come in at 9 am and 1 patients at 9:30 am. Hourly cycle repeats
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Double booking | show 🗑
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Stream/Time-Specific scheduling | show 🗑
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show | Unscheduled walk-ins; Patients are not scheduled for a specific time, but told to come in at intermittent times. They are seen in the order in which they arrive.
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Cluster or categorization booking | show 🗑
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show | A grid with time slots blocked out when physicians are unavailable or the office is closed.
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show | Procedures to prioritize the urgency of a call to determine when the patient should be seen.
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Health Insurance Portability and Accountability Act (HIPAA) of 1996 | show 🗑
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show | An electronic record of health information that is created, added to, managed and reviewed by authorized providers and staff within a single health care organization.
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Advance directive form | show 🗑
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show | An electronic record of health-related information about a patient that conforms to nationally recognized interoperability standards that can be created, managed and reviewed by authorized providers and staff from more than 1 health care organization.
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birthday rule | show 🗑
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reimbursement | show 🗑
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show | Added information or changed description of procedures and services and are a part of valid CPT or HCPCS codes.
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health history form | show 🗑
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Notice of Privacy Practices | show 🗑
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consent | show 🗑
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show | Form that confirms that the patient is responsible for payments to the provider.
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show | Individually identifiable health information that is inputted, stored and shared relating to the health of patients.
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assignment of benefits (AOB) form | show 🗑
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living will | show 🗑
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show | Form that states that the patient does not want to be revived after experiencing a heart episode or other kind of life-threatening event.
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show | A health care professional who has been licensed by the state to provide and coordinate patient care.
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show | When an urgent, but not life-threatening, situation occurs, requiring that the referral be taken care of quickly.
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show | Needed in an emergency situation, and can be approved immediately over the phone after the utilization review has approved the faxed document.
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show | Section of medical charts for patients currently receiving treatment.
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show | Section of medical charts for patients that the provider has not seen for 6 months or longer.
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show | Section of medical charts for patients who have died, moved away, or terminated their relationship with the physician.
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purging | show 🗑
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show | Identifying files for purging by marking the outside of the file.
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provisional diagnosis | show 🗑
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differential diagnosis | show 🗑
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direct filing system | show 🗑
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cross-reference | show 🗑
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show | A HIPAA rule that establishes protections for the privacy of individuals health information.
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show | Documents or bits of information that identify the person or provider enough information so that the person could be identified.
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bookkeeping | show 🗑
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copayment | show 🗑
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encounter form | show 🗑
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show | The amount the patient must pay before insurance pays anything.
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show | A form of cost-sharing that kicks in after the deductible has been met.
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explanation of benefits (EOB) | show 🗑
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show | Document that provides detailed information about charges, payments & remaining amounts owed to the providers.
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allowable amount | show 🗑
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show | System that provides national uniform payments after adjustments across all practices throughout the country.
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show | Person or entity responsible for the remaining payments of services after insurance has paid.
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show | A small amount of company cash available for expenses such as postage, parking fees, small contributions, emergency supplies & misc. small items.
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disbursement | show 🗑
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show | A chronological record of the bills rec'd, bills paid and payments and reimbursements received.
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day sheet | show 🗑
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show | Document consisting of proof of posting sections, month-to-date accounts receivable proof, and year-to-date accounts receivable proof.
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show | A method of bookkeeping that relies on a one-sided accounting entry to maintain financial information.
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show | Document where transactions are entered.
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show | A system in which every entry to an account requires an opposite entry to a different account.
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show | A document where transactions are summarized and later recorded in a general ledger.
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show | The properties owned by a business.
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equities | show 🗑
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liabilities | show 🗑
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show | A document that describes items purchased or services rendered and shows the amount due.
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statement | show 🗑
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first-class mail | show 🗑
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show | First-class mail weighing more that 13 ounces.
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standard mail | show 🗑
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show | Mail that has insurance coverage against loss or damage.
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show | Mail of all classes protected by registering and requesting evidence of it's delivery.
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show | First-class mail that also gives the mail added protection by offering insurance, tracking and return receipt options.
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show | A list of items in a package.
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covered entities | show 🗑
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show | Organizations that use, collect, access and disclose individually identifiable health information, but do not transmit electronic data. These do not have to comply with the Privacy Rule.
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divulge | show 🗑
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business associates | show 🗑
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incidental disclosure | show 🗑
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show | The transfer of electronic information in a standard format.
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National Provider Identifier (NPI) | show 🗑
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HIPAA Security Rule | show 🗑
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firewall | show 🗑
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show | A report that traces who has accessed electronic information.
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show | System that enables the sharing of health-related information among providers according to nationally recognized standards.
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show | Part of the U.S. Department of Labor with the mission to ensure workplace safety and a healthy working environment.
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exposure control plan | show 🗑
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show | Making false statements of representations of material facts to obtain some benefit or payment for which no entitlement would otherwise exist.
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show | Assigning a diagnosis or procedure code at a higher level than the documentation supports, such as coding bronchitis as pneumonia.
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show | Using multiple codes that describe different components of a treatment instead of using a single code that describes all steps of the procedure.
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program abuse | show 🗑
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medical necessity | show 🗑
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Healthcare Integrity and Protection Data Bank (HIPDB) | show 🗑
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Healthcare Fraud and Abuse Program (HCFAP) | show 🗑
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Medigap | show 🗑
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Healthcare Common Procedures Coding System (HCPCS) | show 🗑
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show | A list of guarantees for people receiving medical care.
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show | Written recommendation to see a specialist.
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shared decision-making | show 🗑
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show | Discontinuing medical care without giving the proper notice or providing a competent replacement.
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Blue Cross Blue Shield plan | show 🗑
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show | Use and change of tone or pitch in the voice.
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show | Specific words or expressions used by a particular profession or group and that can be difficult for others to understand.
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template | show 🗑
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show | The part of a letter that immediately precedes the signature, such as "very truly yours" or "sincerely."
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show | A patient presents for treatment, such as an arm to allow a venipuncture to be performed.
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show | Consent for treatment given out loud in response to a pointed question.
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informed consent | show 🗑
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show | Willful and unlawful use of intimidation and physical force or violence on another person.
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show | A person younger than the age of majority (usually 18 to 21 years of age) who is married, in the armed forces, living apart from parents or a guardian, or self-supporting.
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Medicare Summary Notice (MSN) | show 🗑
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show | Health insurance subsidized through premiums paid directly to the company.
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show | The amount paid or to be paid by the policyholder for the coverage under the contract, usually in periodic installments. A pre-established amount set by the insurance company and paid regularly, usually on a monthly basis, by the patient or an employer.
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Medicare | show 🗑
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benefit period | show 🗑
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show | Provides hospitalization insurance to eligible individuals.
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Medicare Part B | show 🗑
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Medicare Advantage (MA) | show 🗑
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show | A medical insurance group that provides coverage of health care services for a period of time and a fixed annual fee.
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preferred provider organization (PPO) | show 🗑
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show | Plan that allows patients to go to any physician, other health care professional or hospital as long as the providers agree to treat those patients.
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show | Model in which providers set the fees for procedures and services.
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show | Form provided to a patient if a provider believes that a service may be declined because Medicare might consider it necessary.
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Medicare Part D | show 🗑
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out-of-pocket maximum | show 🗑
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Medicaid | show 🗑
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show | A program jointly funded by the federal government and the states to cover uninsured children in families with modest incomes too high to qualify for Medicaid.
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managed care organization | show 🗑
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capitation | show 🗑
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show | Formal approval from the insurance company that will cover the test or procedure. Sometimes required by a payer to determine medical necessity for the proposed services.
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preferred provider organization (PPO) | show 🗑
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show | Insurance that is tied to an individual's place of employment.
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show | Electronic data that has been encoded such that only authorized parties can read it.
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administrative services only (ASA) contract | show 🗑
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Hippocratic Oath | show 🗑
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SOAP | show 🗑
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POMR | show 🗑
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show | An organizational approach to keeping medical records:
C=Chief Complaint
H=History
E=Examination
D=Details
D=Drugs & Dosages
A=Assessment
R=Return Visit Info
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show | Term formed from a name.
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active listening | show 🗑
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administrative safeguards | show 🗑
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show | Written statements of a person's wishes regarding medical treatment, such as a living will.
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show | A report that lists outstanding balances that have not been paid by either the patient or the insurance payer.
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anatomy and physiology | show 🗑
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biases | show 🗑
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block scheduling | show 🗑
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carved out | show 🗑
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certified clinical medical assistant (CCMA) | show 🗑
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certified medical administrative assistant (CMAA) | show 🗑
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show | An organization that accepts the claims data from a health care provider, performs edits comparable to payer edits and submits clean claims to the third-party payer.
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show | Sending and receiving information, thoughts, or feelings through verbal words, written words or body language.
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show | Following mandated laws, policies, standards, and guidelines.
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contracts | show 🗑
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coordination of benefits (COB) | show 🗑
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cultural differences | show 🗑
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show | Characteristics of a patient such as name, address, date of birth, contact and insurance necessary for filing.
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diversity | show 🗑
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show | Time when the computer system is not functional and other processes must temporarily suffice.
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eligibility | show 🗑
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empathy | show 🗑
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show | Received same provider services within the last 3 years.
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ethics | show 🗑
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show | Storage, exchange, accessibility and integration of health care records for the overall purpose of optimizing the health of individuals and populations.
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Health Insurance Portability and Accountability Act (HIPAA) | show 🗑
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show | A comprehensive patient questionnaire to assess overall well-being by measuring physical and mental health, including lifestyle factors, fall risk, and cognitive function.
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hospice | show 🗑
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show | An insurance plan in which a provider signs a contract to participate. The provider agrees to accept a discounted rate for procedures.
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show | A period of time between appointments.
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show | Provides health management to patients who are sick, injured or need a routine health exam. LPN's are supervised by providers and RN's.
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malpractice | show 🗑
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medical law | show 🗑
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medical specialist | show 🗑
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show | A combination of Latin and Greek language used to describe components and processes of the human body, medical procedures, diseases, disorders and pharmacology.
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show | Any practice that may result in unnecessary costs to Medicare.
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show | Intentionally submitting false medical claims for payment, receiving incentives for medical services or devices that are federally funded, or making inappropriate referrals.
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National Patient Safety Goals (NPSG) | show 🗑
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negligence | show 🗑
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netiquette | show 🗑
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show | The initial patient appointment or the first encounter after a three year absence from the organization.
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non-participating (non-PAR) provider | show 🗑
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show | Communication type that occurs through expressive behaviors and body language rather than oral or written words.
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show | A registered nurse who possesses additional preparation and skills and is supervised by a physical examination, order and interpret tests, develop treatment plans, and prescribe medications.
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show | Agrees to accept the payer's allowed amount (regardless of the billed amount). This may be referred to as in-network for managed care payers.
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patient abondonment | show 🗑
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show | A partnership between a patient and their care team in which total health is the focus and not just a single condition. Health care team consists of a provider(physician, NP, PA), CMAA, CCMA, nurses & pharmacists.
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show | A reimbursement model intended to improve the traditional fee-for-service method by changing the focus to value-based care rather than volume-based care.
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show | The policies, procedures, and actions used to protect the computers and equipment from hazards and unauthorized access.
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show | Licensed health care provider who works independently with physicians to diagnose illnesses, conduct physical examination, order and interpret tests, develop treatment plans and prescribe medications.
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show | A person who signs a contract with a health insurance company and who owns the health insurance policy.
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show | Software used for the day-to-day administrative business of a health care organization.
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practice management system (PMS) | show 🗑
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show | A request to determine if a service is covered by the patient's policy.
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preferences | show 🗑
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primary care provider | show 🗑
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primary insurance | show 🗑
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professionalism | show 🗑
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show | A written plan that specifies criteria to be followed in defined situations.
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referral | show 🗑
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remittance advice | show 🗑
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revenue cycle | show 🗑
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show | A specific set of standards that a medical professional may perform within the limits of the medical license, registration, and/or certification.
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show | Gathering pertinent health and insurance information.
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show | The insurance plan that is billed after the primary insurance plan has paid its contracted amount.
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technical safeguards | show 🗑
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show | The virtual delivery of health care services remotely.
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telephone etiquette | show 🗑
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show | Insurance coverage in addition to primary and secondary insurance. Tertiary insurance covers gaps in primary and secondary insurance coverage.
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The Joint Commission (TJC) | show 🗑
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therapeutic communication | show 🗑
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show | Scheduling method also referred to as streaming. Set appointment times.
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show | The length of time from the date of service in which a health care organization may submit a claim to the third-party payer. Timely filing varies by payer and may range from 90 days to one year from D of S. Claims that exceed timely filing are not payable
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urgent | show 🗑
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value-based care model | show 🗑
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verification | show 🗑
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workflow | show 🗑
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Created by:
Danielle Mulhern
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