Computers In The Medical Office Chapter 1

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computers in the medical office chapter 1

1996

The year HIPAA was put into action?

email

medical offices use these to send reports, forms and other documents?

tricare

Insurance program that provides coverage for dependents of active duty service members

electronic

The least expensive way to submit claims

audit/edit

this report lists errors on electronic claims before they are transmitted to health plans

office of inspector general

The entity that threat criminal issues for complaints or non-compliance of HIPAA regulations are referred

e-commerce

medical practices participate in this to purchase supplies over the Internet at discount prices

preferred providor organization

Members of these plans usually pay a higher fee if they receive care from a physician outside network

clearinghouse

electronic claims can be processed by these before they are recieved by insurance companies

accounting cycle

The flow of financial transactions in a business

psychotherapy notes, records in legal proceedings, CLIA protected information

The three types of PHI that the patient does NOT have the right to access

Health Information Management HIM

People in this field work with administative and clincial computer systems

copayments

these are collected at the time of service

HIPAA compliant

Clearinghouses format electronic claims into this format

3rd party payer

an insurance carrier; can be private or public (3 words)

health insurance portability and accountability act

The meaning of HIPAA?

practice management program

a program that automates financial and administrative tasks is a medical practice

preferred provider organization

the most common type of managed care plan

clearinghouse

a service bureau that collects electronic claims from medical practices and forwards them to the appropriate health plans

patient information form

a new patient should always complete one of these forms

verifying ID of individual

An example of an Administrative Safeguard under the Security Rule

they process large amounts of information more efficiently

the use of computers in the medical office has led to significant increases in productivity due to this reason

medicaid

insurance provided for people with low incomes

billing process

process that leads to maximum, appropriate, timely payment for patients' medical services

audit trail

these are created to ensure the accuracey of medical data input into the computer

notice of privacy practices

the statement availabe to the patient at their first appointment that outlines individual's rights and covered entity's legal duties in regards to PHI

electronic funds transfer EFT

the capability to deposit insurance payments directly into a practice's account via computer

passwords

many offices assign these to limit access to healthcare information stored on a computer

ICD-9

you can find diagnosis codes in this book

RA

similar to an EOB

lab results, x-ray films, paper records

three examples of PHI

capitation

payments of fixed amounts paid to physicians at regular intervals for providing services to plan members

audit trail

keeps track of data entry on a computer and can be reviewed if security problem arises

procedure CPT

a standardized code that specifies the services the physician provided

medicare

provides coverage for persons 65 and older, persons with disabilities and dependent widows

computer password

An example of a technical safeguard under the HIPAA Security Rule

patient data, transaction data

billing in medical offices depends on these two types of services (data)

speed of transmission, less chance of errors, reduced costs

Advantages of using electronic claims

AMA

CPT was developed by this organization

title I- health insurance reform

Title of HIPAA regarding continuous insurance coverage for workers and their insured dependents when they change or lose jobs

dob, demographic, patient name

three examples of IIHI

collection process

when patient payments are overdue, this is started to collect on the account

transmits clinical data about the patient

a reason why a computer can be a life-saving device in an emergency

medical necessity

established when the diagnosis and treatment of a patient are logically connected

title II- administrative simplification

Title of HIPAA regarding the uniform sets of standards that protect and place limits on how confidential health information is used

locking cabinets

example of a physical safeguard under the HIPAA Security Rule

autoposting

automated entry of information from a remittance advice into a practice management program

appointments

a big advantage of computerized scheduling is that it is easier to find these through a computer search

coding

translates a description of a medical condition into a shorter, standardized code

pre-registering patients

First step in billing cycle

accounts receivable

money coming in to the practice

policy holder

medical insurance represents a contract between this and a health plan

837p

electronic claim format used to bill for a physician's service

information technology IT

refers to the computer hardware and software that medical practices use to accomplish daily tasks

contract

The practice must have this if they use an outside billing service to create and file claims

statement

lists the services performed for a patient, along with the charges for each service

electronic medical records

these can be access from several locations at the same time

day sheet

a report that lists charges, payments and adjustments during a day

insurance has a contract with provider for certain amount for each service, provider agrees/accept that amount as payment for service

The provider's fee schedule is not often the same as the insurance fee schedule. Why not?

consumer driven health plan CDHP

This type of health plan is a high deductible/low premium type of managed care plan

electronic medical record EMR

used to record clinical data

administrative, technical, physical

HIPAA security act outlines these safeguards required to prevent unauthorized access to protected healthcare information (3)

co-insurance

a PORTION of charges that are patient's responsibility

encounter form

also known as a superbill

EMR

unlike the paper form, these do not use a lot of physical space in the office

computerized

these billing programs reduce data entry errors

patients and transactions

computerized accounting system for informationin databases about these (2 things)

patient information

form that includes patients personal, employment and insurance data needed to complete an insurance claim

electronic prescribing

eliminates medication errors that result from illegible handwriting on prescription forms

all healthcare facilities

HIPAA pertains to these

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