medical office cma CIMO medisoft v 16

80 terms by maryq1

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Packing data

the deletion of vacant slots from the database

backup data

a copy of data files made at a specific point in time that can be used to restore data

knowledge base

a collection of up-to-date technical information

Auto log off

feature of medisoft that automatically logs a user out of the program after a period of inactivity

access rights

security option that determines the areas of the program a user can access, and whether the user has rights to enter or edit data

x12-837 Health care claim (837p)

HIPPA standard format for electronic transmission of a professional claim from a provider to a health plan

walkout statement

a document listing charges and payments that is given to a pt after an office visit

electronic medical records

the computerized records of one physician's encounter with a pt over time

HIPPA electronic transaction and code set standards

regulation requiring electronic transactions such as claim transmission to use standardized formats

HIPPA security rules

Regulation outlining the minimum administrative, technical, and physical safeguard required to prevent unauthorized access to protected health care information

personal health record

private, secure electronic files that are created maintained and owned by the pt

electronic data interchange

the exchange of routine business transactions from one computer to another using publicly available communications protocols

national provider identifier

a standard identifier for health care providers consisting of ten numbers

electronic prescribing

the use of computers and hand held devices to transmit prescription in digital format

clearinghouse

a company that receives claims from a provider, prepare them for processing and transmits them to the payers in HIPPA compliant format

protected health information

information about a pt's health or payment for health care that can be used to identify the person

remittance advice

an explanation of benefits transmitted electronically by a payer to a provider

audit/edit report

a report from a clearinghouse that lists errors to be corrected before a claim can be submitted to the payer

procedure code

a code that identifies a medical service

premium

the periodic amt of money that insured pays to a health plan for insurance coverage

preferred provider organization (PPO)

manage care network of health care providers who agree to perform services for plan members at discounted fees

accounting cycle

the flow of financial transaction in a business

accounts receivable

monies that are flowing into a business

capitation

payment to a provider that cover each plan member's health care services for a certain period of time

coinsurance

percentage of charges that an insured person must pay for health care services after payment of the deductible amt

copayment

a fixed fee paid by the pt at the time of an office visit

diagnosis code

a standardized value that represent a pt's illness,signs, and sx

encounter form

a list of the procedures and charges for a pt visit

explanation of benefits

paper document from a payer that shows how the amt of a benefit was determined

fee-for-service

health plan that repays the policyholder for covered medical expenses

health maintenance organization

a manage health care system in which providers agree to offer health care to the organization's members for fixed payment

health plan

a plan, program or organization that provides health benefits

manage care

a type of insurance in which the carrier is responsible for both the financing and the delivery of health care

pt information form

a form that includes a pt's personal, employment, and insurance data needed to complete an insurance claim.

payer

private or government organization that insured or pays for health care on behalf of beneficiaries

policyholder

a person or entity who buys an insurance plan; the insured

collection list

a tool for tracking activities that need to be completed as part of the collection process

collection tracer report

a tool for keeping track of collection letters that were sent

payment plan

an agreement between a pt and a practice in which the pt agrees to make regular monthly payments over a specified period of time

write-off

a balance that has been removed from a pt's account

uncollectible account

an account that does not respond to collection efforts and is written off the practice expected accounts receivable

tickler

a reminder to follow up on an account

prompt payment laws

state laws that mandate a time period within which clean claims must be paid; if the are not, financial penalties are levied against the payer

pt ledger

a report that list the financial activity in each pt's account

case

a grouping of transaction that share a common element

capitation payment

payment made to physician on a regular basis for providing services to pt's in a manage care plan

cycle billing

a type of billing in which statements printing and mailing is staggered throughout the month

electronic remittance advice

an electronic document that lists pt's dates of service, charges. and the amt paid or denied by the insurance carrier

fee schedule

a document that specifies the amt the provider bills for provided services

payment schedule

a document that specifies the amt the payer agrees to reimburse the provider for a service

remainder statements

statement that list only those charges that are not paid in full after all insurance carrier payments have been received

standard statements

statements that shows all charges regardless of whether the insurance has paid on the transaction

aging report

a report that lists the amt of money owed to the practice, organized by the amt of time the money has been owed

practice analysis report

a report that analyzes the revenue of a practice for a specified period of time

selection boxes

fields within the search dialog box that are used to select the data that will be included in a report

database

a collection of related bits of information

purging data

the process of deleting files of pt's who are no longer seen by a provider in practice

rebuilding indexes

a process that checks and verifies data and correct any internal problem with the data

recalculating data

the process of updating balances to reflect the most recent changes made to the data

restoring data

the process of retrieving data from backup storage devices

capitated plan

an insurance plan in which prepayments made to a physician cover the physician's services to a plan member for a specified period of time

chart

a folder that contains all records pertaining to a pt

primary insurance carrier

the first carrier to whom claims are submitted

record of tx and progress

a physician's notes about a pt's condition and diagnosis

referring providers

a physician who recommends that a pt see a specific other physician

sponsor

in tricare, the active-duty-service member

adjustments

changes to pt's accounts that alter the amts charged or paid

charges

amt's a provider bills for the services performed

multilink codes

groups of procedures codes entries that relate to a single activity

NSF check

a check that is not honored by a bank because the account it was written on does not nave sufficient funds to cover it

payments

monies receive from pt's and insurance carriers

once a month billing

a type of billing in which statements are mailed to all pt's at the same time each month.

pt's statements

a list of the amt of money a pt owes, the procedures performed and the dates the procedures were performed

day sheet

a report that provides information on a practice activities for a 24 hours period

insurance aging report

a report that list how long a payer has taken to respond to insurance claim

pt aging report

a report that lists a pt's balance by age, date and amt of the last payments and telephone #

pt day sheet

a summary of pt activity on a given day

payment day sheet

a report that list all payments received on a particular day, organizes by provider

procedure day sheet

a report that lists all the procedures performed on a particular day, in numerical order

collection agency

an outside firm hired to collect on delinquent accounts

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