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68 terms

MOD H WEEK 4

STUDY
PLAY
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