MOD H WEEK 4

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WHAT IS THE INSURANCE INFORMATION AND NAME AND ADDRESS CALLED?

PATIENT INFORMATION FORM

IS AN ARRANGEMENT BY WHICH A PATIENT REQUEST THAT HIS OR HER HEALTH INSURANCE BENEFIT PAYMENT BE MADE DIRECTLY TO A DESIGNATED PERSON OF FACILITY, SUCH AS A PHYSICIAN HOSPITAL

ASSIGNMENT OF BENEFITS

WHY CANT YOU RELEASE INFORMATION OF A PATIENTS MEDICAL RECORD?

PROHIBITED UNLESS PATIENT SIGNS A RELEASE FORM

WHY WOULD A DR NOT GIVE INFORMATION ABOUT HIMSELF TO HIS PATIENTS?

DOESN'T PROMOTED A GOOD PROVIDER PATIENT RELATIONSHIP

WHEN A PATIENTS IS INFORMING HIMSELF ABOUT THE CLINIC SURROUNDINGS AND LOCATION WHAT IS THIS CALLED?

SURROGATES

WHY IS TELEPHONE MANAGING IMPORTANT?

THE PATIENTS STAFF RELATIONSHIP STARTS WHEN THEY MAKE AN APPOINTMENT

WHAT ARE PROBLEM DEBTORS GROUPS

SOMETHING ELSE COME UP
CHRONICALLY SLOW
CANT PAY
FORGETFUL

HOW MANY NUMBERS OF INSTALLMENT PLANS WHICH IS UNDER THE FEDERAL TRUTH IN LENDING ACT ARE THERE?

4

IF A PATIENT DOESNT HAVE HEALTH INSURANCE WHAT DO YOU DO?

QUESTION THE PATIENT WHY

A STATEMENT THAT IS SENT OUT EVERY MONTH WHAT IS IT CALLED?

BILLING CYCLE

WHY SHOULD A MEDICAL ASSISTANCE BACK UP ELECTRONIC FILE?

INCASE OF A FIRE OR FAILER OF THE COMPUTER

WHY WOULD IT BE SMART TO MAKE A NEW GERIATRIC CLINIC AT THIS TIME.

THE NEXT 30 YRS THE BABY BOOMER WILL DOUBLE IN NUMBERS INCREASING OUR GERIATRIC

WHAT IS A PEGBOARD SYSTEM?

SMALL PRACTICE USES IT AND TRANSACTION CAN BE SEEN

A CHRONOLOGICAL RECORD OF ALL PATIENT TRANSACTION, WHICH INCLUDES PREVIOUS BALANCE, CHARGES, PAYMENTS AND CURRENT BALANCES WHAT IS THIS RECORD CALLED

DAILY LEDGER

WHAT IS A DEFENDANT

THE PARTY BEING SUED WHO MAY CHOOSE TO PAY THE DEBT IN FULL PLUS ALL ACCUED FEES BEFORE THE PROCESS GOES ANY FUTHER

IN A LAW CASE IT IS IMPORTANT FOR THE PERSON BRINGING THE CASE TO HAVE EXPLORED ALL OTHER AVENUES BEFORE COMING TO SMALL CLAIMS LAWSUIT WHAT IS THE NAME OD THIS PERSON?

PLAINTIFF

TO TURN OVER ALL ACCOUNTS THAT HAVE NOT PAID THEIR BILLS TO THIS ORGANIZATION WHAT IS IT?

COLLECTION AGENCY

WHAT ACT GOVERNS OVER THE ABUSIVE METHODS USED BY COLLECTION AGENCY?

FAIR DEBT COLLECTION PRACTICES ACT

WHAT IS ACCOUNTS RECEIVABLE?

THE ENTIRE GROUP OF PATIENT LEDGERS

A JOURNAL THAT LISTS ALL EXPENSES THAT ARE PAID TO VENDORS FOR EXAMPLE RENT, OFFICE SUPPLIES AND SALARIES.

DISBURSEMENT JOURNAL

IT KEEPS TRACK OF "CORE PRACTICES'S FINANCIAL RECORDS" WHAT IS THIS PRACTICE'S FINANCIAL RECORDS CALLED?

GENERAL LEDGER

IT KEEPS A LEDGER FOR WAGES AND SALARIES WHAT IS THIS CALLED?

PAYROLL JOURNAL

A TYPE OF LEDGER WHICH INCLUDES ALL CHARGES AND PAYMENTS WHAT IS IT CALLED?

PATIENT LEDGER

ITS A CHRONOLOGICAL LISTING OF ALL TRANSACTION AND IT IS CONSIDERED THE MOST BASIC OF ALL OFFICE RECORDS, WHAT IS CALLED?

GENERAL JOURNAL

REMITTANCE ADVICE WHAT IS THE OTHER NAME FOR IT?

EOB

TO MAKE A RECORD CLAIM INFORMATION ON A COLUMNAR FORM WHAT IS THIS FORM CALLED?

INSURANCE CLAIMS REGISTER OR LOG

IF A CLAIM IS REVIEWED AND PAYMENT DECISIONS ARE MADE BY THE CARRIER WHAT IS THIS PROCESS CALLED?

ADJUDICATION

EIN NUMBER WAHT IS THIS?

EMPLOYER IDENTIFICATION NUMBER

WHAT ARE ERRORS THAT CAN CAUSE A CLAIM TO BE REJECTED?

PROVIDER NOT FOUND
MEMBER NOT FOUND
INCORRECT ADDRESS
REDERING PROVIDER

WHAT NEEDS PREAUTHORIZATION OR PRECERTIFICATION?

INPATIENT HOSPITALIZATION
NEW OR EXPERIMENTAL PROCEDURES
CERTAIN DIAGNOSTIC STUDIES

BEFORE YOU SUMMIT A HEALTH INSURANCE THAT YOU OBTAIN WHAT TYPE OF FORM?

CLAIM ATTATCHMENT

WHAT HEARING IS CONSIDERED TO BE THE MOST PRODUCTIVE?

HEARING ON RECORD

WHAT TWO THINGS YOU NEED FOR AN APPEAL REQUEST?

BENEFITIONARY NAME
MEDICARE INSURANCE CLAIM NUMBER

WHAT 3 WAYS THAT YOY CAN REQUEST A HEARING?

ON RECORD
TELEPHONE
PERSONAL

YOU FILL BLOCK 11 D WHAT DID YOU JUST DO?

YOU MARK YES AND TOU ACCEPTED THE CHARGES

PATIENT HAS 2 INSURANCES YOU HAVE A COORDINATION OF BENEFITS SITUATION WHAT SHOULD YOU DO?

FOLLOW THE BIRTHDAY RULE

WHAT CLAIM IS SUBMITTED WHEN A PERSON HAS 2 INSURANCE?

SECONDARY/ PAYER

WHAT ARE THE 3 THINGS WHEN FREQUENCY OF SUBMITTING CALIMS DEPEND ON?

SIZE OF PRACTICE
TYPE OF CLAIM
HOW OTHER CLAIMS ARE SUBMITTED

YOU DONT AGREE WITH YOUR INSURANCE COMPANIES DECISION ON SOMETHING YOU ARE GOING TO CALL FOR A REVIEW OF THEIR DECISION WHAT IS THIS PROCESS CALLED?

APPEALS

OCCASIONALLY A PATIENT AND SPOUSE (OR PARENT) ARE COVERED UNDER TWO SEPARATE EMPLOYER GROUP POLICIES RESULTING WHAT IS THIS?

COORDINATION OF BENEFITS

HOW LONG DO YOU HAVE TO SUBMIT A CLAIM?

30 DAYS

WITH PATIENTS ACCOUNT, THE HEALTH INSURANCE PROFESSIONAL OR OTHER STAFF MEMBER POSTS THE PAYMENTS RECEIVED FROM THE INSURANCE CARRIER TO THE PATIENT LEDGER AND BILLS THE PATIENT FOR ANY APPLICABLE OUTSTANDING CO PAY OR DEDUCTIBLE AMOUNTS WHAT IS THIS?

EOB

A CORRECTED CLAIM IS MARKED HOW?

CORRECTED BILLING

WHAT IS INCLUDED IN AN ATTACHMENTS?

PRACTICE NAME, PROVIDER/ GROUP NUMBER, TELEPHONE NUMBER

WHAT DO YOU DO WHEN A PATIENT HANDS YOU A INSURANCE CARD?

PHOTOCOPY IT

SHOULD HEALTH INSURANCE BE CHECKING EVERY TIME THE PATIENT COMES IN ?

YES IT CAN CHANGE IN A DAY

WHAT IS THE FIRST LEVEL OF APPEAL PROCESS?

APPEAL REQUEST

WHEN DOING PROCEDURAL CODING HOW MAY LEVELS ARE THERE?

3

WHAT CODES DO PHYSICIANS USE TO REPORT THEIR SERVICES?

E/M CODES

PROVIDES HEALTH CARE COVERAGE THOROUGH CIVILIAN NETWORKS OR TRICARE AUTHORIZED PROVIDERS FOR-UNIFORMED SERVICE MEMBERS AND THEIR FAMILIES WHO ARE ON REMOTE ASSIGNMENT, WHICH IS 50 MILES OR MARE FROM A MTF WHAT IS THIS?

TRICARE PRIME REMOTE

WHAT CODES FOLLOW SIX SECTIONS IN THE MAIN BODY OF CPT MANUAL?

CATEGORY 3

IF TREATMENT IS UNAVAILABLE AT A MTF, THE INDIVIDUAL SOMETIMES MUST OBTAIN A STATEMENT WHAT IS THIS?

NAS STATEMENT

WHEN A SPOSE OR DEPENDENT CHILD OF A VETERN HAS PERMANENT AND TOTAL SERVICE CONNECTED CONDITION WHAT INSURANCE ARE ELIGIBLE FOR?

CHAMPVA

WHAT ARE ATHE 2 TYPE OF DISABILITIES?

SHORT/ LONG

WHRERE CAN YOU FIND ADVERSE EFFECTS OF DRUGS OR OTHER CHEMICAL SUBSTANCES?

SECTION 2 OF VOLUME 2

THE INDEX TO DISEASES HAS TWO TABLES WHAT ARE THEY?

INJURIES AND POISONINGS

WHAT DIAGNOSIS DO PHYSICIANS AND PATIENT CLINIC USE?

PRIMARY

WHAT DIAGNOSIS DO HOSPITALS ANS INSTITUTIONAL FACILITIES?

PRINCIPAL

WHAT IS FOUNDATION FOR DIAGNOSTIC CODING THAT AIDS IN ASSIGNING DIAGNOSTIC CODES CORRECTLY?

E/M CODES

WHAT IS THE BOTTOM HALF OF THE CMS 1500 FORM USED FOR?

PHYSICIAN / SUPPLIER

WHAT ARE THE 3 GUIDELINES FOR SCANNABLE CLAIMS FOR OCR?

CAPITAL LETTERS, MM DD YYYY, NO PUNCTUATION OR SASH USE SPACE, 2 FOR DECIMAL, NO WHITE OUT

WHAT ACT ESTABLISHED QUALITY STANDARDS FOR LABS?

CLIA

WHAT IS THE DURATION OF TIME WHEN A MEDICARE BENEFICIARY IS ELIGIBLE FOR INPATIENT HOSPITAL OR SKILLED NURSING FACILITY CHARGES?

6 MONTHS OPEN ENROLLMENT PERIOD

OCR WORDS BEST WITH ORIGINAL COPIES USING WHAT?

MONOSPACED FONT

WHERE IS PATIENT INFORMATION USED ON THE CMS FORM?

TOP HALF

WHEN THE ATTENDING HEALTH CARE PROVIDER RECOMMENDS THAT THE PATIENT SEE ANOTHER PHYSICIAN (OFTEN SPECIALIST) FOR A PROBLEM USUALLY ASSOCIATED WITH ONE MAJOR BODY SYSTEM WAHT IS THIS?

CONSULTATION

WHAT IS THE TERN FOR A WRITTEN COMPLAINT THAT YOU SUBMIT TO INSURANCE COMPANY?

GRIEVANCE

WAHT IS A PPO

PREFERRED PROVIDER OPTION

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