Administrative Duties 8% Flashcards
____sorting of patients and allocation of care or treatment according to the urgency of their needed.
Triage
___situations require immediate care
Emergent
__means they should be seen within 24 hours
Urgent
___can be seen at the next available appt
Routine
Always err on the side of caution when you are doing____
triage
In triage, if there is any doubt or you have questions____
always ask the physician
____triage conversations in the chart
document
What information should be gathered when pts present with ocular problems?
Get patient’s name, phone number, determine essence of problem, when symptoms first occurred, duration, which eye, if chemical exposure:Immediately irrigate eye with water x 20 minutes and bring substance in with them to the office or ER
What should pt do if they get chemical in the eye?
Immediately flush they eye for 20 minutes with water (before coming into the office), place eyes open under running water rolling eyes around
What are the general guidelines with ocular triage?
Confer with physician when in doubt, return call asap if call is not handled immediately, avoid giving general medical advice or discussing diagnosis, answer questions in friendly but non-committal manner (refer to Dr. for definitive answer), if emergency and your physician is not in office, refer to the on call ophthalmologist or ER
When making appointments you should not say the following things, what should you instead say?
a. When do you want to come in ?
b. The doctor is running late
c. I called to remind you..
d. Are you a patient here?
e. Cancellation
f. Are you on medicare?
g. You misundertood
a. Would you prefer morning or afternoon
b. The doctor was interrupted in his schedule today
c. I called to confirm
d. When did we last see you?
e. Change in schedule
f. What type of insurance do you have
g. There must have been a misunderstanding
What are the things that should be done with arriving patients?
Confirm identity, ask for ID and insurance, avoid asking date of birth or SSN in front of others, Retrieve file of established pts, new patient; who referred?, avoid keeping pts waiting longer than 15 minutes.
When should pt have a definite appt scheduled?
For pts with pathology on concern (glc , pituitary tumor), post op pts, if the physician requests a specific follow up appt
Why is recall system used?
To remind pts to come back when they are not coming back at a definitive time in a short period of time. These are reminder cards or letter (texts). It is critically important that we use this system so pts aren’t lost to follow up.
_____patient should be given priority appt
surgery
For post op patients it is good to…
make a courtesy call the day of sx, answer questions quickly, never allow post op pts with concerns to feel ignored or abandoned.
There should be a set ___ in office for how to handle incoming test results and letters or reports from other doctors
protocol
It is very important that ___test results are reviewed by doctor
all
Never file test results away without…
the doctor reviewing first
If pt misses an appt or cancels sx ___
record in medical record
How should sales reps be handled?
-Ask for business card
-Many physicians want to meet with sales reps to learn about new treatments
-Physician preference dictates how to handle
-Differentiate pharmaceutical, medical equipment and optical sales reps from other types of sales people (ex. advertising sales or insurance sales)
-Be ready to divert sales reps physicians do not want to see or reps taking too much of the phsicians time
Medicare part B is for…
Part A is for…
physicians services
hospital services
What does it mean if doctor “accepts medicare assignment”?
They agree to let medicare set fees
Cannot bill pt for chargers over and above the “medicare allowable” fees
What is the purpose for coding?
To determine the complexity of service and reimburse according to level of complexity.
The Health Care Common Procedure Coding System?
HCPCS,
System that classifies procedures according to categories for purposes of claims processing
HCPCS
HCPCS is coded with
alpha-numeric
Level I: CPT-4 codes: office visits and procedures that we do
Level II: DME (durable medical equipment-optical goods)
Code of the procedure that was performed.
CPT (current procedural terminology)
Code of diagnosis (why the services were performed)
ICD code (international classification of diseases)
The period after the surgery during which all necessary and related services are not seperately payable
Global period
Global period varies by ___
Minor is typically ____days
Major is typically ___days
procedure
10
90
When pt is in global period and need unrelated service you must bill with a __
modifier code 24
What does the modifier code 24 indicated to insurance company?
that we know pt is in post op period but this procedure is unrelated to their recent sx.
How many coding systems can we use in ophthalmology and optometry?
2
What are the 2 types of codes used in ophthalmology and optometry?
Eye code (92xxx): general evaluation of complete visual system
E&M codes (99xxx): evaluation and management codes; used by all specialties
(We are the only sub-specialties that have their own coding system)
E&M codes are harder to document because..
they have more stringent documentation requirements especially regarding HPI.
Eye codes can vary by..
different regions of the country and vary by carrier 7-10 elements typical
How many elements are there to E&M codes and what are they?
3
(history(HPI, ROS, PFSH), exam, medical decision making)
E&M coding is intimately related to how comprehensive your…..
HPI is
(the more descriptive used the higher weight it carries for evaluation in management coding)
The exam is comprised of ___elements
12
(VA, tonometry, pupils, adnexa exam, motility)
Medical decision making is based on ___elements
4
Dx(how tough to diagnose)
MGMT(how hard to manage)
DATA(how much data needs gathered, do we need to order any tests)
RISK(how much risk is here for the pt)
A universally recognized claim for we submit to insurance companies to request payment for a patients services
HCFA 1500 Claim form
Medicare has a ______, which is an authorization a pt signs which allows us to release their dx to medicare and if we are accepting pmt from medicare for their charges it will be a release to allow them to pay us
one time authorization
(pt only has to sign one time)
after first time we document “pt request for pmt on file”
A written notification to the patient that their insurance probably will not pay for a particular service.
-must list the fee
-must be given to the pt before the service is performed
-give pt a copy
-modifier GA
ABN
Advanced Beneficiary Notice
What procedure is excluded from needing an ABN?
Refraction
