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Medical Billing > Chapter 2 > Flashcards

Chapter 2 Flashcards

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USMLE® Step 1 flashcards
1
Q

Medical care

A

Includes the identification of disease and the provision of care and treatment to persons who are sick, injured or concerned about their health status.

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2
Q

Health care

A

Expands definition of medical care to include preventative services. Help avoid health and injury problems.

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3
Q

Health Insurance

A

A contact between policy holder and a third party payer or government health program to reimburse policy holder for all or a portion of the cost of medically necessary treatment or preventative care.

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4
Q

Policy holder

A

Person who signs a contract with a health Insurance

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5
Q

Third-party payer

A

Is a health Insirance company that provides coverage such as blue cross blue shield.

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6
Q

Group health insurance

A

Insirance coverage subsidized by employers and other organizations

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7
Q

Individual health insurance

A

Prívate health Insurance policy purchased by Individuals or families who do not have access to group health INsurance coverage. (Aetna)

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8
Q

Public health insurance

A

Federal and state government health programs. Ex. Medicare, Medicaid, chip, tricare
Available to eligible ppl

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9
Q

Single payer system

A

Centralized health care system adopted by some western nations (Canada) and funded by taxes. The gov pays for your health care.

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10
Q

Socialized medicine

A

A type of single payer system in which the government owns and operates health care facilities and providers. (Physicians) receive salaries (Finland, Great Britain)

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11
Q

Universal health Insurance

A

The goal of providing every I do usual with access to health coverage, regardless of the system implemented to achieve the goal. (Obamacare)

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12
Q

Continuity of care

A

Involves documenting patient care services so that others who treat the patient have a source of I formation to assist with additional care and treatment

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13
Q

Problem-oriented récord (POR)

A

Is a systematic method of documentation that consists of four components

  • data base
  • problem list
  • initial plan
  • progess notes
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14
Q

Electronic health record (EHR)

A

Health information in a digital format that is created and shared by providers across more than one healthcare setting , such as hospitals , emergency departments, labs, ambulatory surgery centers and outpatient diagnostic facilities.

EHR contains info from all providers involved in patients care. All that are authorized Can access

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15
Q

Record linkage

A

Allows patient Info to be created at different locations according to a unique patient identifier or I identification number

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16
Q

Electronic medical record (EMR)

A

A digital versión of the patients chart in a medical office. The days that is contained in an EMR cannot be electronically shared with other physicians, specialist or Insititutions

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17
Q

Personal health record (PHR)

A

Web based application that allows individuals to maintain and manage their health information. In a private secure and confident environment

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18
Q

Total practice management software (TPMS)

A

Used to generate EMR automating the following medical practice functions.

  • registering patients
  • scheduling appt
  • generating insurance claims and patient statements
  • processing payments from patient to third party payers
  • producing administrative and clinical reports
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19
Q

Electronic clinical quality measures (eCQMs)

A

Use data from electronic health record (EHR) and health Information technology systems to measure health care quality.

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20
Q

Promoting Interoperability (PI) programs

A

Previously called EHR incentive programs. Focus on improving patient access to Health Info. And reducing time and cost required of providers to comply with the programs requirements

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21
Q

Quality payment program (QPP)

A

Hemos providers focus on quality patient care and making patients healthier that includes advanced alternative payment models (advanced APMs) and a merit based incentive payment system (MIPS)

22
Q

Alternative payment model (APM)

A

Payment approach that gives added incentive payments to provide high quality and cost efficient care

23
Q

Advanced alternative payment models (advanced APMs)

A

A subset of APMs and include new ways for CMS to reimburse health care providers for care provided to Medicare beneficiaries

24
Q

Merit based incentive payment system (MIPS)

A

Combines parts of the physician quality reporting system (PQRS), the value modified , and the Medicare electronic health record incentive program into one single program that allows providers to earn a performance based payment adjustment.

25
Q

Self Pay patients

A

Not insured and covered by health insurance

26
Q

Policy holder

A

A person in who’s name the insurance policy is issued to.

27
Q

Dependents

A

Family members of the policy holder who are covered under the policy.
Legal spouse and dependent children.

28
Q

Benefits

A

Amounts paid by the insurance company for covered health care items and services

29
Q

Exclusions

A

Describe anything the insurance company will not cover. Varies from plan to plan. Ex. Pre existing medical conditions

30
Q

Medical underwriting

A

Means that the Insurance company screens the applicants to find out about their health status and risk factors.

31
Q

Guaranteed issue

A

Is a policy that is issued to an I dividí al regardless of age, pre existing conditions , or other factors that might predict the use of health services.

32
Q

Deductible

A

The amount of money that the patient must pay for covered medical expenses before the insurance reimbursement begin. Deductibles are usually an annual amount.

33
Q

Coinsurance

A

Is the percentage of costs a patient shares with their health insurance. Ex. 80/20 coverage where insurance pays 80% and patient pays 20%

34
Q

Copayment or copay

A

A specified dollar amount that the patient must pay to a healthcare provider for each visit or medical service provided.

35
Q

Health insurance marketplace

A

Individuals who don’t have health insurance through their work are eligible to use the marketplace to compare plans and purchase coverage

36
Q

Medicare part A

A

Reimbursed facilities for inpatient care, skilled nursing care, hospice care and home healthcare

37
Q

Medicare part b

A

Reimburses physicians for inpatient and out patient services

38
Q

Medicare

A

Is a federal health insurance programs for people aged 65 and older. People under age 65 with certain disabilities and people of all ages wihh end stage renal disease.

39
Q

Childrens health insurance program (CHIP)

A

Gives health Insurance and preventative care to 1 in 7 uninsured American children.

40
Q

Worker compensation

A

A plan that is mandated by state governments requiring employers to cover employees who get sick or injured on the job.

41
Q

TRICARE

A

A healthcare program for active duty and retired uninformed services members and their families

42
Q

CHAMPVA

A

Healthcare coverage for souses, widows, and children of veterans with disabilities that are entirely service related

43
Q

Indian Health Service (IHS)

A

An agency within the U.S. department of health and human services. Responsible for providing a comprehensive health service delivery system to native (north) American individuals and First Nations peopke who live in Alaska.

44
Q

Cost control

A

Medical record control the cost of healthcare by eliminating unnecessary or redundant services

45
Q

Legal document

A

Medical records help healthcare providers defend against malpractice or other inquiries concerning patient care

46
Q

Financial document

A

Medical record provide documentation that a doctor saw a patient or performed a service and that ensures payment by third party payers

47
Q

SOAP notes

A
  • Subjective: reason patient is in office
  • objective: vital signs, findings and results
  • Assessment: diagnoses of condition
  • Plan: what doctor will do to treat
48
Q

Practice management software

A

Cloud based software that is designed to support many of the administrative and financial functions of a medical practice.
Automate a variety of office tasks such as
-scabbing of insurance cards
-verifying insurance eligibility
-processing Insurance claims
-scheduling appt
Etc

49
Q

Payer mix

A

Different types of Health insurance payments that are part of the providers payer mix

50
Q

Patient record or medical record

A

Documents Health care provided to a patient

Medical Billing (7 decks)

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