New Provider Team
Create new charge procedure
Referral Issues Team
Questions as to how providers should drop charges
WQ for Professional Billing Team
WQ for HIM Team
Complete fee schedule updates
Hospital Patient Status
Lab Printer Routing
Labor and Delivery
how to view patient radiology images
Patient Access Team addresses
MAR issues for RNs
Ordersets or Smartsets team
NDC missing team
Update preference cards
Team to update surgical order sets
who should correct anesthesia record
New Radiology Procedure
Type of ticket for CPN data not interfacing
federal health insurance plan primarily for seniors
setting for inpatient care
federal law requiring employer to permit employees to continue their group health insurance coverage after termination
conducting ourselves ethically and within the law of business practice
collection and storage on patient demographic, insurance and clinical data
official count/list of patient population
document verifying patient name
portion of bill that beneficiary must pay once insurance benefits have begun
a practice to reduce anxiety
joint federal and state program to provide medical insurance for the poor
having a short, relatively severe course
not to be disclosed
making an appointment
admitted for multi-day stay
ABN Advance _______ notice
MSP Medicare ________ payor
EMTALA Emergency Medical Treatment and ______ Act
position requires employee to have goo medical terminology and administrative skills
with addition training in the ophthalmic field medical assitant can become a
provides basic nursing care to patients in nursing and retirement homes
lab tech who specializes in the formation,structure and function of cells
clerical and chairside assistant of dentists
provides special training to perform dental services including radiology, apply meds and patient education
skilled in performing EKGs in clinic/hospital settings
also know n as a medical technologist works under the supervision of a pathologist
trained to work in physician offices on both th clinical and admin side
professional nurse who completed a nursing program and passed examination
professional nurse with extensive training in labor and delivery
Registered nurse with a masters degree who works under the supervison of a physician
has basic nursing skills and commonly work in hospitals and nursing homes
specialized training in nutritional management
has associate degree and works under the supervision of a Registered Occupational Therapist
assist licensed pharmacist in preparing medications
extensive training in drawing blood from veins
trained in certain aspects of the practice to provide assistance; under direct supervision of physician
training in radiology procedures; assist radiologist
performs routine clerical, communication and reception tasks in a hospital setting
The process of establishing the need for a service?
A provider's list of charges for services provided.
The amount the insurance company determines to be customary price for a service, usually less that what the provider charges?
Fixed percentages of the cost of a service paid by the patient or a second insurance?
Fixed amount paid by the patient at the time of service?
Payment for health insurance policy?
A complete correct claim or a claim with no errors?
The primary provider who arranges for specialists or hospitalizations?
The medical insurance policy that is billed first?
National Provider Identification
Centers for Medicare and Medicaid Services
Managed Care Organization
Diagnosis Related Group
Advance Beneficiary Notice
Coordination of Benefits
Primary Care Provider
Common for insurance to require approval for?
Used to identify a procedure on a claim form?
Family members of the insured are called?
REVENUE CYCLE MONITORING
PHYSICIAN FEE SCHEDULE
VALUE ADDED NETWORK
THIRD PARTY PAYER
ABUSE AND FRAUD
electronic medical record
Fee schedules are updated by third-party payers.
Performance of Internal - facility based staff (HIM P.) & External - consultants hired for purpose ( corporates that specialize), Scope, Frequency & size of sample depends: size of organ, available resources, number of code profess., history of noncompliance, risk factors, case complexity, results of initial assessments
Per person premiums, provide all contracted hc services that the covered individuals needs over a specific period of time, calculated on project cost - per patient per month or per member per month
A Healthcare program for dependent and survivors of permanently and totally disabled veterans
A medical condition that coexists with the primary cause for hospitalization and affects the patient's treatment and length of stay
A medical condition that arises during an inpatient hospitalization (for example, a postoperative wound infection)
The amount of money that the patient is responsible for before the insurance kicks in is called the
The computer software program that assigns appropriate MS-DRGS according to information provided for each episode of care is called a
Which of the following is not a place where PACE services can be provided?
Which of the following plans reimburses patients up to a specified amount?
Title XIX of the Social Security Act Amendment of 1965 is also known as
In this model, healthcare services are contracted with two or more multispecialty group practices instead of just one
What data set is used for patient assesments by the home health prospective payment system?
A payment under the medicare outpatient prospective payment system that includes items such as anesthesia, supplies, certain drugs, and the use of recovers and observation rooms
Which of the following terms is used for the amount charged for a medical
The MS DRG prospected payment system rate is based on what type of diagnosis?
The type of payment system where the amount of payment is determined before the service is delivered is called
What is the name of the federally funded program that pays the medical bills of
Uses multiple codes that Describe individual components of a procedure rather than an appropriate single code that describes all steps of procedure preformed.
Assigning a diagnosis/procedure code specifically for purpose to obtain higher payment
Upon which criterion is Medicaid eligibility-based?
A contract with a company where the subscriber pays a regular premium in exchange for a defined set of benefits
Reffered to as family doctor/PCP this person administers routine and preventive care, and makes referrals for specialty services when needed.
A provider who focuses on one area of medicine. Like a cardiologist or neurologist
A contracted, pre-determined dollar amount insurance company requires a patient to pay for a particular medical service. (It requires patients to pay a small amount upfront to deter people from seeking medical care that may not be necessary.)
The contracted rate a health insurance company will pay toward a specific medical service.
A contracted, pre-determined percentage of the allowable charge that a patient is required to pay for a particular medical service (after the deductible is met and before the out-of-pocket maximum is met).
A pre-determined annual amount patient must pay before insurance begins to cover.
Annual maximum amount patient is required to pay for in-network medical services per his/her insurance plan contract (typically, copay + coins + deductible)
The person who is responsible for payment of the monthly premium, or whose employment is the basis for the coverage.
A person entitled to health insurance benefits under the subscriber’s plan.
A specific package of benefits negotiated between the company and the employer.
Dates during which the insurance plan is active.
Explanation of Benefits is a statement from the insurance company that details payments and adjustments made for services. EOBs go to both the provider and the patient.
/Response from the insurance company that states no payment will be made. (service could be not covered by the insurance plan, or the insurance company may need more information.)
The order in which the claim is sent to insurance companies. If patient has more than one insurance plan, we must determine which insurance should be billed primary, secondary, etc. Primary: the first insurance company designated to pay toward their allowable charges. Secondary: the second insurance company designated to pay toward their allowable charges.
The pathway a patient takes from one provider to another. Referrals may be required by insurance before a patient can be seen by the other provider.
The process whereby a physician must obtain insurance approval before a patient receives certain treatment or drugs (study, test, procedure, surgery.)
SOCIAL SECURITY NUMBER
BLUE CROSS BLUE SHIELD
UNITED HEALTH CARE
Radiology is a __________ science.
Once the radiologist determines a diagnosis they can find a _______ for the patient.
Official doctor in charge of reading scans.
Scans can determine different ________.
Radiology lab device used to take pictures.
Digital image of a body part.
High-energy that is transferred from machines to the body.
Machines take pictures to ________ an illness.
Picture of body taken from machine.
When a scan shows a bone split in half it is ________.