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Certified Medical Assistant > Module 15: Administrative Assisting > Flashcards

Module 15: Administrative Assisting Flashcards

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USMLE® Step 1 flashcards
1
Q

appointment book

A
  • book used to schedule, cancel, and reschedule appointments
  • can be color-coded or arranged so a week is shown at a glance
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2
Q

matrix

A

template used for scheduling

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3
Q

template

A

outline used to make new pages with a similar design, pattern, or style

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4
Q

disadvantages of paper charts

A
  • only be used by one person at a time
  • easily misplaced from filing errors
  • cannot be easily shared
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5
Q

advantages of electronic medical record

A
  • accomplishes many tasks in one system
  • decrease medical errors
  • decrease time spent correcting things
  • secure way to communicate with pt
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6
Q

wave scheduling

A
  • three pts scheduled at same time
  • seen in order they arrive
  • one pt arriving late won’t disrupt schedule
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7
Q

modified wave scheduling

A
  • two pts scheduled at same time with third arriving about 30 mins later
  • time sequence continued throughout the day
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8
Q

double booking

A
  • two pts scheduled at same time to see same provider
  • often used to work in pt with acute illness
  • creates delays in schedule that continue through day
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9
Q

info for scheduling appointment with established pt

A
  • pt name
  • date of birth
  • reason for visit
  • time provider will need for visit
  • any day or time pt prefers
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10
Q

info for scheduling appointment with new pt

A
  • demographic info (name, address, DOB, phone number, insurance, SSN, emergency contact)
  • registration forms completed (notice of privacy practices, medical history form)
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11
Q

how long should pt wait in waiting room with effective scheduling

A

no more than 15 mins

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12
Q

what to do when pt doesn’t show up

A
  • recorded in medical record
  • may have to pay a fee
  • may discharge pt if continued cancellations or missed appointments
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13
Q

automated call routing system

A
  • offers pt option of canceling, confirming, or rescheduling appointments
  • keeps track of what pts choose
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14
Q

steps for filing

A
  • conditioning
  • releasing
  • indexing and coding
  • sorting
  • storing and filing
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15
Q

conditioning

A
  • grouping related papers together
  • removing paper clips and staples
  • fixing damaged records
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16
Q

releasing

A
  • marking form to be filed with mark of designated preference
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17
Q

indexing and coding

A
  • determining where to place original record in the file
  • if it needs to be cross-referenced in another section
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18
Q

sorting

A
  • ordering papers in filing structure
  • placing documents in specific groups
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19
Q

storing and filing

A
  • securing documents permanently in the file
  • ensure medical record documents do not become mispalced
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20
Q

alphabetic filing

A
  • traditional system in provider’s offices
  • most widely used
  • arranged by last name, first name, middle initial
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21
Q

numeric filing

A
  • typically combined with color coding
  • used for larger health centers or hospitals
  • allows for unlimited expansion without shifting files
  • saves time for retrieving and filing charts
  • additional pt confidentiality
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22
Q

subject filing

A
  • general correspondence using alphabetic or alphanumeric filing methods
  • all correspondence dealing with particular subject is placed under specific tab
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23
Q

first step when deciding whether to purge, transfer, or retain a medical record

A
  • determine if it’s active, inactive, or closed
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24
Q

how long do facilities preserve most medical records (including Medicare or Medicaid records)

A

minimum of 10 years

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25
Q

Health Insurance Portability and Accountability Act (HIPPA)

A
  • does not require specific method for medical record disposal
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26
Q

what should you document when you destroy a medical record

A
  • when
  • how
  • by whom
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27
Q

things in medical record

A
  • lab reports
  • radiology reports
  • nurses notes
  • medications
  • flow sheets
  • provider progress notes
  • administrative forms
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28
Q

how are things filed in medical record

A
  • chronological
  • reverse chronological
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29
Q

SOMR

A
  • source-oriented medical record
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30
Q

SOAP

A
  • subjective
  • objective
  • assessment
  • plan for treatment
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31
Q

CHEDDAR

A
  • chief complaint
  • history
  • examination
  • details
  • drugs and dosages
  • assessment
  • return visit info
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32
Q

what must provider use system for to meet federal criteria to qualify for CMS incentives

A
  • e-prescribing
  • communicating with pts
  • computerized provider order entry (CPOE): includes lab and radiology orders
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33
Q

encryption

A

when data is translated into code that requires the use of a password to unlock

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34
Q

security measures for electronic records

A
  • passwords
  • encryption
  • firewalls
  • antivirus programs
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35
Q

why is accurate documentation important

A
  • ensures continuity of care among all healthcare providers
  • functions as evidence in courts of law
  • aid researchers in gathering statistical info
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36
Q

CPOE

A
  • computerized physician order entry
  • allows providers to order lab and radiology testing, treatment, referrals, prescriptions
  • use increased in 2009 when HITECH Act and Meaningful Use program were implemented
  • created to improve safety of medication orders
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37
Q

how must requests for medical records be provided

A

in writing

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38
Q

where should the release of medical records be filed

A

in pt chart

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39
Q

who can present legal power of attorney to authorize them viewing pt medical records

A

the pts attorney

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40
Q

first step in check-in process

A

greeting pts

41
Q

what should you do in the reception area at the end of each day

A
  • sanitize chairs, counters, and door knobs
42
Q

demographic info needed on registration form

A
  • full name
  • DOB
  • guarantor name and relationship to pt
  • address
  • phone number
  • marital status
  • spousal info (if any)
  • place of employment
  • SSN
  • driver’s license number
  • emergency contact info
43
Q

two primary forms of identification during check-in process

A
  • driver’s license or other ID
  • insurance cards
44
Q

when does pt sign consent to treat form

A

before seeing provider unless emergent situation

45
Q

when is written informed consent required

A
  • when invasive procedure or treatment will be performed
  • any situation requiring in-depth understanding of treatment or procedure
46
Q

implied consent

A
  • minimally invasive procedure
  • venipuncture, EKG
47
Q

how to prepare for the day ahead

A
  • print daily schedules
  • answer messages from the night before
  • ensure all rooms are stocked
48
Q

copay

A
  • specified sum of money based on pt insurance policy benefits
  • due at time of service
49
Q

coinsurance

A
  • amount policyholder is responsible for
  • just meet deductible before insurance will contribute
  • typically 80/20 ratio
50
Q

deductible

A
  • specific amount pt must pay out of pocket before insurance pays
  • usually reset after a year
51
Q

explanation of benefits (EOB)

A
  • provided to pt
  • what services were paid, denied, or reduced in payment
52
Q

remittance advice (RA)

A
  • EOB sent to provider
  • electronic fund transfer info or check for payment
53
Q

advance beneficiary notice (ABN)

A
  • Medicare pt signs when provider thinks Medicare won’t pay for service
  • needs to be signed before service provided
  • copy given to pt
54
Q

federal insurance policies

A
  • Tricare: covers military personnel and their dependents
  • Medicaid: funded by federal gov, managed by state, covers those who meet specific eligibility
  • Medicare: federal program, covers people over 65
  • Workers compensation: state legislative law, protects employees against cost of care resulting from work-related injury
55
Q

private insurance policies

A
  • group policies: offered through employer who pays portion of premium and deducts remainder from paycheck
  • individual policies: individual funds themselves, may pay entire premium if self-employed
56
Q

info needed to verify insurance coverage

A
  • full name
  • DOB
  • policy number
  • SSN
57
Q

Federal truth in Lending Statement

A
  • signed by pt
  • arranges for payments from local organizations that last longer than 4 months
58
Q

ICD-10-CM

A
  • contains 55,000 more codes than ICD-9-CM
  • more specific reporting of diseases and newly recognized conditions
  • 3 to 7 characters used
  • alphabetical, numeric, numeric, either, either, either, either
  • placeholder allowed for future expansion of codes
59
Q

ICD-10-PCS

A
  • PCS: procedure coding system
  • system comprised of medical classifications for procedural codes
  • typically in hospitals
60
Q

CPT codes and modifiers

A
  • current procedural terminology codes
  • document procedures and technical services
  • all info in medical record must be correct for correct code to be documented
61
Q

HCPCS

A
  • healthcare common procedure coding system
  • group of codes and descriptions that represent procedures, supplies, products, and services not covered by CPT codes
  • updated every year
  • enhance uniform reporting
  • typically for Medicare and Medicaid insurance plans
62
Q

forms necessary to send out claims

A
  • pt encounter form
  • treatment or progress notes
  • history and physical exam notes
  • discharge summaries
63
Q

two types of claims to submit for payment for services

A
  • paper claim: manually filled out and mailed to insurance carrier, all uppercase, nothing handwritten
  • electronic claim: generated electronically, processed through direct billing or clearinghouse
64
Q

chart reviews

A
  • collection and clinical review of medical records to ensure payment is made for only services that meet all plan coverage and medical necessity requirements
  • reduce payment errors
65
Q

three factors in determining level of service within evaluation and management coding

A
  • history: problem-focused, detailed, or comprehensive
  • examination
  • medical decision making
66
Q

what is used to examine medical records or claims for accuracy and completeness

A
  • auditing methods, processes, and sign-offs
67
Q

referral

A
  • document or form required by insurance companies
  • used when provider wants to send pt to specialist
  • documented in pt medical record
68
Q

types of referrals and long processing takes

A
  • regular: 3 to 10 business days
  • urgent: 24 hrs
  • stat: as soon as possible
69
Q

what is included in a referral

A
  • demographic info
  • insurance info
  • NPI
  • diagnosis
  • planned procedure or treatment
70
Q

preauthorization

A
  • process required by some insurance carriers
  • provider obtains permission to perform specific procedures or services or refers pt to specialist
  • required by most managed care and HMO insurance for procedures or treatments outside primary care office
71
Q

info needed to get prior authorization

A
  • authorization code
  • date authorization is effective
  • date authorization expires
  • authorizes diagnosis and procedural codes
  • contact info for specialist office
  • how many visits are authorized
  • what authorization has been issued for
72
Q

precertification

A
  • process required by some insurance carriers
  • provider must prove medical necessity before performing procedure
  • usually needed within 24 hrs for hospitalization
  • sometimes needed for lab test, diagnostic testing, procedures considered unusual or expensive (MRI, chemo)
73
Q

participating providers

A
  • agree to adjust difference between amount charged and approved contracted amount insurance company will reimburse
  • only bill pt for deductible, copay, coinsurance, or amounts due
  • insurance company will pay provider’s office directly for covered services
74
Q

account balance

A
  • total balance on an account
  • can be debit (negative) or credit (positive)
75
Q

debit

A

amount owed

76
Q

credit

A

monetary balance in individual’s favor

77
Q

accounts receivable

A

amount owed to provider for services rendered

78
Q

accounts payable

A
  • debt incurred but not yet paid
79
Q

assets

A

property of an individual or organization that is subject to payments for debts owed

80
Q

liabilities

A

items that are debts

81
Q

two types of billing methods

A
  • manual
  • computerized systems
82
Q

computerized billing system

A
  • software generates report for accounts according to last time payment was made
  • determine which accounts are 30, 60, or 90 days old
83
Q

manual billing system

A
  • accounting forms, ledgers, receipts used on peg board system
  • cumbersome and time-consuming
84
Q

when is billing sent

A

before the 25th of each month

85
Q

NSF

A
  • nonsufficient funds
  • check returned and medical office can charge additional fees to pt account
86
Q

electronic fund transfers (EFT)

A
  • for payroll disbursements, money owed to business institutions, payments from insurance companies and other gov organizations
  • insurance payments trough EFTs deposited 1 to 2 weeks faster than conventional check
  • processed through automated clearinghouse that follows federal rules and regulations
87
Q

charge reconciliation

A
  • add deposits
  • deduct outstanding checks
  • deduct bank service charges
  • add interest earned and EFTs collected by bank
  • if bank statement and office accounts do not balance, initiate full investigation
  • if error is discovered, add or deduct errors in company’s cash account
88
Q

how often should you balance and obtain accounts receivable total

A
  • once a month
  • after posting all charges and payments
89
Q

aging report

A
  • grouped by last day of payment or by date of service if no payments have been made
  • 0 to 30 days, 30 to 60 days, 60 to 90 days, 90 to 120 days
  • make reminder call, mail letter, set up plan, send account to collections
90
Q

two primary reasons claims are denied and rejected

A
  • technical errors
  • insurance policy coverage issues
91
Q

steps to appeal denial

A
  • determine why claim was denied
  • obtain and complete insurance company’s appeal document
  • include letter from provider to give medical necessity
92
Q

telephone etiquette

A
  • speak clearly
  • hold mouthpiece 1 in away from lips
  • maintain confidentiality
93
Q

network

A

two or more computer systems connected together

94
Q

data field

A

location where data is stored within computer program

95
Q

Electronic medical record (EMR)

A
  • digital chart used within a facility
96
Q

Electronic health record (EHR)

A
  • includes EMR and other info to be used between facilities
97
Q

what should you do in a fire or natural disaster

A

make sure all pts are evacuated and accounted for prior to exiting

98
Q

responsibility of OSHA

A
  • reduce workplace injuries, illnesses, and fatalities
  • all facilities with more than 10 employees must have written emergency evacuation plan and reviewed annually

Certified Medical Assistant (40 decks)

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