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Administrative Office Procedures

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Term
Definition
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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