How can we help?

You can also find more resources in our Help Center.

80 terms

medical office cma CIMO medisoft v 16

STUDY
PLAY
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