Module 11- Administrative Testing Flashcards
What is a revenue cycle?
a series of administrative functions required to collect payment for services provided by the HCO.
What is a referral?
is an order from a provider to see a specialist to get specific medical services.
What is a practice management system (PMS)?
the administrative side of the EHR. Allows for scheduling appointments and tracking patient demographics, performing billing procedures, submitting insurance claims, and processing payments.
What is the difference between an EMR and an EHR?
EMR is an electronic medial recored containg health and medical care info within a specific HCO. The biggest difference is that EHRs are maintained by multiple providers, while EMRs are only maintained by a single provider. This means that an EHR contains more information than an EMR.
what is Real-Time Adjudication?
is the ability of the HCP to share documents and make decisions while a patient is present.
What are Medicare/ Medicaid services and what is the difference?
Medicare is federal health insurance for anyone age 65 and older, and some people under 65 with certain disabilities or conditions. Medicaid is a joint federal and state program that gives health coverage to some people with limited income and resources.
What is a schedule Matrix?
the designed time frame for appointments is based on the method of appointment durations
Explain the different types of scheduling: ( based on time)
1. Specific Time:
2. Wave Scheduling:
3. Double-booking:
4. Clustering:
1- when a patient is given an individual time for their appointment.
2- scheduling multiple patients in the same time period, and patients are seen based on who arrives first. (Allows for more flexibility).
3- A system in which 2 or more patients are scheduled within the same time period.
4- scheduling patients in groups with similar medical needs.
Who is defined as a new patient:
first-time patients or first encounter after a 3-year absence from the organization.
types of office visits and the associated requirements:
1. Establoished Patients-
2. Comprehensive-
3. Preventive care-
4. Urgent-
5. other entities-
6. New Patient- Above
1- patients who have received services from the same provider or group for three years
2- new or established patients for a specific complaint regarding injuries, or worsening chronic conditions.
3- A thorough review of body systems including preventive screenings.
4- Medically necessary within 24 hours.
5- Non- patient related. For example, meetings, training, etc.
Duration of each type of visit:
1. New patient-
2. Established patient-
3. Comprehensive-
4. Preventive care-
5. Urgent-
6. Other entities-
1- 60 min
2- 15 min
3- 45-60 min
4- 45-60 min
5- 20 min
6- 30 min
What is an after vist summary (AVS)?
info that includes follow-up appointments, provider orders, instructions, educational resources, and financial account info.
Deductible:
Coinsurance:
- the amount that must be paid before benefits are paid for by the insurance company.
- the % of the allowed amount the patient will pay once the deductible is met.
What is notice of privacy practices?
a document that identifies how a provider will share a patient’s HI.
What does the administrative section of a pateint’s medical record include:
1- patient’s demographics
2- Notice of privacy practices
3- advance directive
4- consent forms
5- Medical release forms
6- correspondence messages
7- appointments and billing information.
What does the clinical section of the medical record include:
Health History
Physical examinations
Allergies
Medication record
Problem list
progress notes
Laboratory data
Diagnostic Procedures
continuity of care.
What is an encounter form?
Encounter notes?
- A record of the diagnoses and procedures covered during the current visit a.k.a superbill.
- clinical notes that include history of present illness and current medications list.
What is a patient flow sheet?
a sheet that records and tracks a patient’s health data
What is a chart review?
performed to make sure the encounter, prescriptions, follow-ups, and communication are all accurately documented.
- utilization review:
- precertfication:
- preauthoraization:
- a process used by payers to inform providers of policy payments, benefits, and authorizations.
- a request to determine if a service is covered by a patient’s policy and what the remaining payment would be.
- approval of insurance coverage and necessity of services prior to the patient receiving them.
Daignostic and proecedual codes:
1. Current procedural terminology (CPT):
2. HCPCS:
3. ICD-10-CM:
- states the medical services and procedures performed.
- Supplies and services not described by CPT
- Includes diseases, injuries, medical conditions, patient status, and other reasons for the encounter.
