26 terms

AMA - Chapter 1 - Out of Book

Non-Physician Practioners (NPP's)
An individual such as a physician assistant, nurse practioner, advanced registered nurse practioner, certified nurse anesthetist, physical therapist, speech therapist, liscensed clinical social worker or certified registered nurse practioner wo has not pbtained a medical degree but is allowed to see patients and prescribe medications.
Relative Value Units (RVU's)
1) the cost (Overhead) of delivering care,
2) Malpractice insurance
3) The Physician's work
Centers for Medicare and Medicaid Services (CMS)
A federal organization taht sets the mandates for financing and delivery of care to Medicare and Medicaid beneficiaries in the United States.
Charge Entry
Pertains to inputting (Posting) charges for patients care service rendered into the system.
Managment Services Organizations (MSO's)
An outsourced company that performs a variety of business functions such as accounting, billing, coding, collections, computer suppoert, legal advice, marketing, payroll, and managment expertise.
Multiskilled Health Practioners (MSHPs)
A person who is cross trained to provide more than one function, often more than one discipline.
Claims Assistant Professional (CAPs)
These people work for the consumer. They help patients organize, file, and negotiate health insurance claims of all types; assist the consumer in obtaining maximum benefits.
Cash Flow
Is the amount of actual money available to the medical practice
American Health Information Managment Association (AHIMA)
Has published diagnostic and procedure coding competencies for outpatient services and diagnostic coding and reporting requirements for physician billing.
Respondeat Superior
Also known as Vicarious Liability, physicains are legally responsible for their own conduct and any actions of their employees performed withing the context of their employment.
Errors and Omissions
Prothections against loss of money caused y failure through error or unintentional omission on the part of the individual or service submitting the insurance claim.
The standars of conduct by which an insurance billing specialist determines the propriety of his or her behavior in a relationship.
To report incorrect information to the Aetna Casualty Company is...
To report incorrect information to a medicare fiscal intermediary is...
In certain circumstances it may be ______ for two physicians to treat the same patient for the same ocndition.
Vicarious Liability
When a physician is legally responsible for an employee's conduct performed during employment.
Professional billing is done for a...
Physician Extenders
Health care professionals trained to provide medical care under the direct or indirect supervision of a physician.
The individual responsible for documenting the patient's clinical notes and assigning a diagnosis cose and a procedure code for medical services rendered is the...
Multi-Skilled Health Practioners
Individuals cross-trained to function in more than one job.
Federal and State Programs
Third-Party payers that require the provider to submit insurance claims for the patient.
Physicians are paid according to relative value units that are based on the cost of delivering care, malpractice insurance, and the physicain's work.
It is not necessary to refer to coding books because medical practices use a fee schedule.
It is the coder's responsibility to inform administration or his or her immediate supervisor if unethical or illegal coding practices are occuring.
When one code is available that includes all of the services, it is permissible to bill using seperate codes for the services.
Depending on the circumstances of the case, am insurance billing specialist acn be held personally responsible under the law for billing errors.