Module 11 - Administrative Assisting

Question 1

practice management system (PMS)

Answer 1

• administrative side of the EHR
• allows scheduling appointments, entering and tracking patient demographics, performing billing procedures, submitting insurance claims, processing payments, and other administrative duties.
• includes the patient medical record where the encounter form resides.

Question 2

Wave scheduling

Answer 2

Scheduling two or three patients during a designated hourly time period (last 30 min of the hour, patients seen in order of arrival).

Question 3

Clustering

Answer 3

Patients are scheduled in groups with common medical needs (schedule all new patients on Tuesdays or all wellness exams on Fridays).

Question 4

New patient

Answer 4

Has not received services from the provider or same group (and same specialty) within 3 years—includes known complaint/condition
60min

Question 5

Comprehensive patient and time of appt

Answer 5

New or established patient for a specified complaint at highest coding level, multiple complaints, injuries, or worsening chronic conditions

45-60 min

Question 6

What are challenges of paper records?

Answer 6

Paper files can be cumbersome and take up a lot of space, only one user can access at a time, and they are challenging to search.

Question 7

T or F. Patients have the option to agree to or decline having a picture taken or photo ID scanned.

Answer 7

True

Question 8

What can be used to verify a patient’s identification?

Answer 8

Driver’s license

Question 9

Encounter form/Superbill

Answer 9

Records the diagnosis and procedures covered during the current visit

Question 10

Which of the following is included on the encounter form (superbill)?

A: Third-party payer
b: Reason for the visit
c: Employer
d: Guarantor

Answer 10

b: Reason for the visit

Question 11

precertification vs preauthorization

Answer 11

precert - A request to determine if a service is covered by the patient’s policy and what the reimbursement would be.

preaut - Approval of insurance coverage and necessity of services prior to the patient receiving them.

Question 12

Utilization review

Answer 12

process used by payers to inform providers about policy payments, benefits, and authorizations.

Question 13

Which methods can be used to request a referral?

Answer 13

1. Electronic via EHR
2. Phone call
3. Website

Question 14

Cons of low-tier plan

Answer 14

lowest-tier plan can have a lower monthly premium, but coverage could be 60% by the payer and 40% by the patient

Question 15

pros of higher-level plans

Answer 15

highest-level plan can have a higher monthly premium, but the coverage could be 90% by the payer and 10% by the patient.

Question 16

Procedural codes (CPT® and HCPCS)

Answer 16

assigned according to what medical services were provided relating to the diagnosis code

Question 17

Diagnosis codes (ICD-10-CM)

Answer 17

describe the condition, cause, manifestation, location, severity, and type of injury or disease.

Question 18

code set: Current Procedural Terminology (CPT®)

Provide what the code identifies and examples

Answer 18

• Medical services
• Procedures performed ​​​​​​​by the provider
• ex. Office visit, Laboratory test​​​​​​​, Lesion removal

Question 19

code set: Healthcare Common Procedure Coding System
(HCPCS)

Provide what the code identifies and examples

Answer 19

• Supplies, Procedures ​​, Services not described by CPT
• ex. Medical supplies, Therapies​​​​​​​, Transportation

Question 20

code set: International Classification of Diseases, 10th revision, Clinical Modification
(ICD-10-CM)

Provide what the code identifies and examples

Answer 20

• Diseases, Injuries, Medical conditions, Patient status affecting health care​​​​​​​ and Other reasons for health care encounters
• ex. Hypertension, Falls, poisoning, Signs/symptoms, Screenings, Vaccinations​​​Implanted medical devices or hardware

Question 21

Common Insufficient Documentation Errors

Answer 21

Incomplete progress notes
Unauthenticated medical records (missing signatures and dates)
No evidentiary radiographs to support medical necessity
Insufficient documentation supporting conservative medical management was attempted
Documentation that did not support certification of the plan of care for physical therapy​​​​​​​
Incorrect coding of Evaluation and Management (E/M) services to support medical necessity

Question 22

The Advance Beneficiary Notice of Noncoverage (ABN)

Answer 22

form used for fee-for-service (FFS) Medicare beneficiaries when the service may not be covered

Question 23

T or F. If an Advance Beneficiary Notice of Noncoverage (ABN) is not signed prior to service and Medicare denies the claim, the patient is responsible for the amount and the provider must be paid by the patient

Answer 23

F. If an ABN is not signed prior to service and Medicare denies the claim, the patient is not responsible for the amount and the provider will not be paid

Question 24

Interoperability helps to ensure what

Answer 24

health care organizations and professionals have access to the patient health record to provide timely and appropriate care

Question 25

Reconciliation

Answer 25

the process of ensuring that the accounts are all balanced and accurate.

Question 26

Incentive Models​​​​​​​

Answer 26

part of the transition from strictly FFS (fee for service) to value-based programs.

Question 27

Examples of incentive models

Answer 27

• Pay for Performance (P4P),
• Accountable Care Organizations (ACO),
• Patient -Centered Medical Home (PCMH).

Question 28

Accounts receivables (A/R)

Answer 28

any amount of money that is anticipated to be paid to it, including medical services billed.

Question 29

Accounts receivables aging report

Answer 29

used so that the older debts can be addressed first

Question 30

Health record auditing is done to ensure that

Answer 30

documentation is complete, correct, and signed by the provider and that the details support the codes (e.g., CPT, HCPCS, and ICD-10-CM) reported for reimbursement and quality purposes.

Question 31

Cycle billing

Answer 31

billing in segments throughout the month—for example, accounts with last name starting with A through F are billed in the first week of the month, G through M the second week, and so on.

Question 32

clearinghouse

Answer 32

an intermediary that is contracted by the provider to accept and process the claims for the third-party payers and assists with reducing claim errors

Question 33

Clearinghouse benefits

Answer 33

• scrubbing claims prior to final submission
• reducing the number of errors in claims
• allows you the opportunity to correct before submission to the payer

Question 34

If the claim is denied stating the service “does not meet medical necessity,” what should you do?

Answer 34

attach supporting documentation and submit with an appeal.

Question 35

supply chain

Answer 35

consists of a relationship between a company and its suppliers to produce and distribute a specific product to buyers.

Question 36

inventory supply log

Answer 36

Form that tracks the amount of inventory the office has and can be used to predict anticipated amounts needed based on the history.

Question 37

threshold/ par level

Answer 37

Minimum amount of inventory an office will have on the shelf before placing another order.

Question 38

What are some conditions that can be diagnosed via telehealth

Answer 38

skin conditions, gastrointestinal system symptoms, aches and pains related to the musculoskeletal system, and headaches,

Question 39

How long are ICD-10-CM diagnosis codes:

Answer 39

• 3-7 characters
• First character is always alphabetic. Second character is always numeric

Question 40

How long are CPT codes?

Answer 40

• 5 digits
• can be either numeric or alphanumeric, depending on the category

Question 41

customary charge

Answer 41

A range of the usual fee that providers in specified geographical area all charge for a service