Administrative Asssisting Flashcards
What role do diagnostic and procedural codes play in patient medical records?
They are essential for accurate patient records and reimbursement from third-party payers
Accurate coding ensures proper billing and reflects the services provided.
What are diagnosis codes (ICD-10-CM) assigned based on?
They are assigned according to the reason for the visit
This includes the patient’s stated condition and provider’s assessment.
What do procedural codes (CPT® and HCPCS) represent?
They represent medical services provided related to the diagnosis code
Includes procedures and tests performed by healthcare providers.
What is the purpose of utilization review?
To inform providers about policy payments, benefits, and authorizations
It is often required for elective and costly procedures.
What is preauthorization?
It indicates that a patient’s health insurance carrier has verified coverage for a service
It is commonly required for certain medical procedures and therapies.
What should be verified during the patient check-in process?
Patient identity, eligibility, and insurance information
This prevents claim denials due to inaccurate information.
What is the purpose of the patient check-out process?
To review the after-visit summary and address any follow-up needs
It includes collecting any additional financial responsibilities.
What does practice management software facilitate?
It aids in generating patient statements and managing billing processes
It improves efficiency in the revenue cycle.
What is cycle billing?
Billing in segments throughout the month based on patient last names
Helps larger facilities manage billing more effectively.
What is a clearinghouse in medical billing?
An intermediary that processes claims for third-party payers
It helps reduce claim errors before submission.
What is the function of a patient flow sheet?
To record and track patients’ health data, such as vitals or lab results
It aids in monitoring patient progress over time.
What does an encounter form/superbill record?
It records the diagnosis and procedures covered during the current visit
It is essential for generating claims for billing.
What is the significance of charting in medical records?
It documents patient findings and supports continuity of care
Includes evaluations and communications with other professionals.
What must be included in the documentation process of electronic health records?
Person, date, and time of any modifications made
This ensures accountability and traceability of the records.
Fill in the blank: The diagnosis and procedure code must link to support _______.
[medical necessity]
True or False: Precertification guarantees reimbursement for services.
False
Precertification indicates coverage but does not confirm medical necessity.
