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Raintree > Definitions > Flashcards

Definitions Flashcards

Terminology/Abvs

1
Q

Practice

A

Services provided for the business
(eg. PT/OT/ABA)

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2
Q

Clinic

A

Location of the business
(eg. Good Shepherd)

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3
Q

Business

A

The term for the operation encompasses the financial/management aspects
(Can include multiple practices and/or clinics.)

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4
Q

Outpatient

A

Patients receiving care outside of the hospital setting
(Therapy/Rehab post hospital/ppc treatment)

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5
Q

Inpatient

A

Patients receiving care inside the hospital setting
(Not a good fit for RT - Care-homes, Skilled Nursing Facilities [SNF} etc.)

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6
Q

Home Health

A

Broad term for delivery of care outside of a traditional clinic or office
(dig deeper in convo)

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7
Q

Medicare (A)

A

Med Services delivered by [MD,RN, BSN, CNP]. Inpatient hospital stays, care in SNF, hospice, HH.
(Not a good fit for RT)

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8
Q

Medicare (B)

A

Med Services NOT delivered by [MD, RN, BSN, CNP]. Covers services, outpatient care, and other services not provided in (A), but necessary.
(eg. Therapy, nutrition, well checks, counseling, etc… Good fit for RT)

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9
Q

Medicare

A

Medical coverage provided by the Federal Gov for people 65< ; some younger w/ disabilities.
(eg. Social security)

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10
Q

Medicaid

A

Coverage provided by the state gov and partially financed by the fed gov. Nations public health insurance for people w/ lower income.

(covers 1/5 Americans)

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11
Q

Electronic Medical Record (EMR)

A

Term used for medical/clinical record for a specific specialty/practice.

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12
Q

Electronic Health Record (EHR)

A

Historical medical record for all EMR records.

(eg. interchangeably with EMR)

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13
Q

Practice Management (PM)

A

Part of the software that runs the practice/business

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14
Q

Scheduler

A

Manages clinic practice schedule

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15
Q

Clinical Notes

A

Medical notes on the patient EMR
(from PCP - outpatient practice)

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16
Q

Reporting

A

Aspect of the PM that creates reports on data within the EMR/PM
(eg patients progress throughout the treatment)

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17
Q

Billing & Collections

A

Managing AR process (Accounts Receivables). Sends claims to a payor via a clearinghouse

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18
Q

Clearinghouse

A

Term for a data exchange between payor and billing system

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19
Q

Revenue Cycle Management (RCM)

A

General term for the entire Billing & Collection process

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20
Q

In-house Billing

A

Business/Practice has its own internal staff managing the RCM process

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21
Q

Outsourced Billing

A

Business/practice outsources some or all of the RCM to a third party.
(usually for a fee ranging from 2-7%)

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22
Q

Health Language 7 (HL7)

A

A data connection between two systems using a defined language. Critical part of the interoperability requirements in the healthcare industry

defined by:
HHS - Health & Human services
CMS - Centers for Medicare & Medicaid Services

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23
Q

Interoperability

A

Ability of two systems to exchange data

24
Q

Drummond Certification (ONC-ACB)

A

Third party certification company that reviews software for specific functionality, interoperability, security etc.

ONC - Office of the National Coordinator for Health Info Tech
ABC - Authorized Certification Body

(raintree is ONC-ACB certified)

25
Q

Claim

A

Bill sent to a payor for medical service

26
Q

CMS/HCFA 1500
(“hic-fa)

A

It’s the work of the (CMS), which is devised to facilitate Medicare & Medicaid reimbursements. Standard health insurance claim form used for submitting physician & professional claims to bill Medicare providers.

(CMS-1500 is used for individual provider claims and is used to submit charges under Medicare Part-B. )

27
Q

837,271,835,270,275

A

Electronic file types that contains patient claim information. Different file types are used in certain situations or for a specific purpose

(eg. 837 file is called a Transaction Set. This file is submitted to an insurance company or to a clearinghouse instead of printing and mailing a paper claim)

28
Q

UB04 (CMS-1450)

A

All institutional providers may use the UB-04 form to bill claims, such as hospitals, specialists, mental health centers, hospices, rehabs, organ procurement organizations and therapy services. This is the standard health insurance claim form used for submitting physician and professional claims to bill Medicare providers.

29
Q

American National Standards Institute Claim File (ANSI)

A

Specific claim file format used universally by all billing systems, clearinghouses and payors. ANSI is the main organization supporting the development of technology standards in the United States.

ANSI works with industry groups, and it is a U.S. member of the International Organization for Standardization (ISO) and the International Electrotechnical Commission (IEC). There is an ANSI format for all claim types

30
Q

Adult Therapy

A

Therapy Services provided to Adults:
Physical Therapy (PT)
Occupation Therapy (OT)
Speech-Language Pathology (SLP)

31
Q

Physical Therapy (PT)

A

The treatment of disease, injury, or deformity by physical methods such as massage, heat treatment, and exercise rather than by drugs or surgery.

32
Q

Occupational Therapy (OT)

A

A form of therapy for those recuperating from physical or have developmental disability that encourages rehabilitation through the performance of activities required in daily life

33
Q

Speech-Language Pathology / Speech Therapy (SLP)

A

Prevents, assesses, diagnoses, and treats speech, language, social communication, cognitive-communication, and swallowing disorders in children and adults.

34
Q

Applied Behavior Analysis (ABA)

A

Therapy is based on the science of learning and behavior. ABA seeks to understand how behavior works, how behavior is affected by the environment, how learning takes place (they primarily work with Autistic kids)

35
Q

Audiology

A

the branch of science and medicine concerned with the sense of hearing. Often used in conjunction with Speech Therapy

36
Q

SOAP Note

A

The Subjective, Objective, Assessment and Plan (SOAP) note is an acronym representing a widely used method of documentation for healthcare providers. The SOAP note is a way for healthcare workers to document in a structured and organized way.

37
Q

Clinical Note- RT

A

The clinical note is the primary tool used to document care, communicate plans and provide guidance for follow-up treatment and care. Gaps in the quality of clinical documentation could, therefore, adversely affect patient care and health care outcomes.

38
Q

Claim Queue

A

The dashboard showing all claims and where they are in the RCM process. The claim que is essentially the work tasks for a biller that tells them what work needs to be done on a specific claim in order for it to be processed and eventually paid

39
Q

Exceptions-Based RCM (Raintree)

A

An RCM process that simplifies the work for a Biller by showing claims that are outside of the “expected”. Usually, this is for claims that haven’t been paid within the expected time frame or under/overpaid based on the expected amount

40
Q

Account-Based RCM

A

An RCM process that shows all claims for an account or patient regardless of where the claim is in the RCM process

41
Q

Patient Engagement (Connect)

A

“Patient engagement” is a broader concept that combines patient activation with interventions designed to increase activation and promote positive patient behavior, such as obtaining preventive care or exercising regularly.

42
Q

Lead

A

an unqualified contact

43
Q

Prospect

A

qualified contact who has been moved into the sales process

44
Q

Marketing Qualified Leads (MQL)

A

Leads that generally fit into the target market but haven’t been fully qualified yet

45
Q

Sales Qualified Lead (SQL)

A

Marketing Qualified Leads that have been qualified and will become a prospect

46
Q

Sales Accepted Lead (SAL)

A

Sales Qualified Leads that have been fully qualified and accepted by Sales and is now an Opportunity

47
Q

Visits (VPM)

A

General term used for when a patient is seen by a provider. These are “billable” events for which the business can charge the patient or payor

48
Q

Units

A

When submitting a claim, the payor receives the visit info and is converted to “units”. Each healthcare industry uses different medical billing services and codes. In this system, each unit represents the specific amount of time the therapist spent providing treatment.

49
Q

CPT Codes

A

A billing unit describes the number of times you performed the service for a patient

A CPT code allows you to correctly describe and bill for the time you spent treating a patient.

Service-based time codes are for treatments that don’t require the continuous presence of the therapist, like an evaluation.

You can only bill these services once, no matter how much time you spend performing them.

50
Q

Payor

A

Term for the organization or businesses that pay for services.
(eg. Medicare, Medicaid, private insurance, Blue Cross, Aetna, Kaiser, Tricare, etc)

51
Q

Commercial Insurance

A

Private insurance (Blue Cross, Aetna, Kaiser, etc)

52
Q

Cloud Based

A

AWS (Amazon) cloud services. No installed software except for the thin-client. EMR is browser-based

53
Q

Browser-Based

A

EMR is accessed through a common browser (Chrome, Edge, Safari, etc)

54
Q

MIPS
(Merit-Based Incentive Payment System)

A

MIPS is the program that will determine Medicare payment adjustments. Using a composite performance score, eligible clinicians (ECs) may receive a payment bonus, a payment penalty or no payment adjustment.

55
Q

EVV
(Electronic Visit Verification)

A

Required in some instance to ensure that the location of service is correct. Required on a state by state basis

Raintree (6 decks)

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