Medical office questions and answers
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The flow of financial transactions in a business is a | show 🗑
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Money that flows into a business | show 🗑
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show | billing cycle
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a form of translating a description of a condition into a shorter, standardized code is | show 🗑
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A series of steps that determine whether a claim should be paid | show 🗑
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show | coinsurance
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show | capitation
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a small fixed fee paid by the patient at the time of an office visit | show 🗑
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show | encounter form
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type of managed care in which a high-deductible/low-premium insurance plan is combined with a pretax savings account to cover out-of-pocket medical expenses, up to the deductible limit | show 🗑
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show | diagnosis
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show | diagnosis code
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show | Explanation of Benefits (EOB)
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a managed health care system in which providers agree to offer health care to the organization's members for fixed periodic payments from the plan | show 🗑
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show | managed care
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A health plan that repays the policyholder for covered medical expenses | show 🗑
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a plan, program, or organization that provides health benefits | show 🗑
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show | medical necessity
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form that includes a patient's personal, employment, and insurance data needed to complete an insurance claim | show 🗑
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show | medical coder
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show | policyholder
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managed care network of providers that agree to perform services for plan members at discounted fees | show 🗑
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show | payer
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software program that automates many of the administrative and financial tasks required to run a medical practice | show 🗑
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a code that identifies a medical service | show 🗑
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show | procedure
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show | statement
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an EOB transmitted electronically by a payer to a provider | show 🗑
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the periodic amount of money the insured pays to a health plan for insurance coverage | show 🗑
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show | Protected Health Information
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What is TPO? | show 🗑
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show | preauthorization or certification number
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What guidelines ensure when a patient has more than one policy, maximum appropriate benefits are paid but, not duplications? | show 🗑
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show | birthday rule
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Who gets a walk out receipt or walkout statement? | show 🗑
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Why would a practice not want to accept a debit or credit? | show 🗑
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What is PPO? | show 🗑
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show | Health Maintenance Organization
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What are these examples of: Indemnity, Managed Care, HMO, and PPO | show 🗑
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a report that lists errors in a claim | show 🗑
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What is the information about a patient's past, present, or future physical or mental health or payment for health care that can be used to identify the person? | show 🗑
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What is an organization that receives claims from a provider - checks, and prepares them for processing - transmits them to insurance carriers in a standardized format? | show 🗑
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What is the use of computers & handheld devices to write & transmit prescriptions to a pharmacy? | show 🗑
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show | electronic data interchange (EDI)
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show | national provider identifier (NPI)
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What is Information Technology (IT)? | show 🗑
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show | X12-837 Health Care Claim (837P)
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show | HIPPA electronic transaction & code sets standards
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regulation guidelines that identify the safeguards required to prevent unauthorized access to electronic health care information | show 🗑
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show | benefit payment information
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show | calendar year
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show | patient
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The section of an EOB that identifies the total deduction, noncovered charges, and balance the patient may owe is the | show 🗑
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A provider that is able to balance-bill a patient for the amount over the allowed charge is referred to as a | show 🗑
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show | downcoded
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If an a claim is downcoded, the medical office assistant should | show 🗑
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show | state insurance commissioner
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show | appeal
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Medicare Part B says the main reason for returning an appeal is due to the lack of a | show 🗑
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show | it didn't happen
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show | subjective, objective, assesment plan
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show | subjective
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show | subjective
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When an objective, unbiased group of physicians determines what payment is adequate for services provided, the process is called | show 🗑
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Many _____ _____ may see re-billing as a duplicate claim, fraudulent billing, and a notice that payment is delinquent. | show 🗑
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What if some services on a claim were over looked by the provider's office; or if charges on the orginal claim were not detailed; or if the medical office specialist made a mistake on the claim? Would these be reasons to re-bill? | show 🗑
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show | audit
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show | copy both sides
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show | Customer service number #, ID # or policy #, Group #, Co-pay, Co-insurance & Admission certification
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show | the policy that names them as the policyholder is the primary policy
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show | Physcian's note
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show | superbill
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Confriming that the services will be covered by the patient's plan is | show 🗑
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Contacting the insurer to verify an active policy is | show 🗑
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show | policy number or ID number
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#'s or letters that connect the patient to an individual policy with a specfic group of other insureds is a | show 🗑
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show | policyholder
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show | primary Insurance policy
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