Chapter One and Chapter Two (W#1)

Question 1

adjudication

Answer 1

a series of steps that determine whether a claim should be paid

Question 2

CPT

Answer 2

Current Prodecural Terminology- the standardized classification system for reporting medical procedures and services.

Question 3

PMP

Answer 3

practice management programs - software programs that automate many of the administrative and financial tasks in a medical practice

Question 4

encounter form

Answer 4

a list of the procedures and diagnoses for a patient’s visit.

Question 5

EOB

Answer 5

explanation of benefits - paper document from a payer that shows how the amaount of a benefit was determined

Question 6

fee- for-service plan

Answer 6

a model of physician reimbursement in which payment is provided for specific, individual services provided to a patient

Question 7

ICD-10-CM

Answer 7

International Classification of Diseases, Tenth Revision, Clinical Modification

Question 8

meaningful use

Answer 8

the utilization of certified EHR technology to improve quality, efficiency, and patient safety in the healthcare system

Question 9

Notice of Privacy Practices

Answer 9

a printed document given to the patient that explains the medical offices use and disclosure PHI (protected health information)

Question 10

ACA

Answer 10

Affordable Care Act - federal legislation passed in 2010 that includes a number of provisions designed to increase access to healthcare, and explore new models of delivering and paying for healthcare

Question 11

EHR

Answer 11

electronic health record - a computerized lifelong healthcare record for an individual that incorporates data from all providers who treat the individual

Question 12

HCPCS

Answer 12

codes (pronounced hick-picks) used for supplies, equipment, and services not included in CPT codes

Question 13

HITECH Act

Answer 13

Health Information Technology for Economic and Clinical Health Act

Question 14

HIT

Answer 14

health information technology - technology that is used to record, store and mangae patient healthcare information

Question 15

HIPPA

Answer 15

Health Insurance Portability and Accountability Act of 1996 - federa act that set forth guidelines for the standardizing of electronic data interchange of administrative and financial transactions, exposing fraud and abuse in government programs, and protecting the security and privacy of health information

Question 16

PCMH

Answer 16

patient centered medical home - a model of primary care that provides comprehensive and timely care to patients, while emphasizing teamwork and patient involvement,

Question 17

List 3 Provisions of the ACA:

Answer 17

1. Expanding MEdicaid to all non medicare eligible individuals under age 65 with incomes up to a cetrtain level, optional on a state-by-state basis.
2. prohibiting health plans from placing lifetime limits on the dollar value of cocerage and prohibit insurers from denying or canceling coverage except in cases of fraud
3. creating health insurance exchanges through which individuals who do not have access to employer or public insurance with premiums and cost sharing

Question 18

List 5 core features of a PCMH

Answer 18

Patient centered

comprehensive, coordinated, quality/safety, access

Question 19

List 4 functions of a PMP

Answer 19

• managing collections activities
• verifying eligibility and benefits
• monotring status of claims
• creating financial productivity reports