Module 15: Administrative Assisting Flashcards
appointment book
- book used to schedule, cancel, and reschedule appointments
- can be color-coded or arranged so a week is shown at a glance
matrix
template used for scheduling
template
outline used to make new pages with a similar design, pattern, or style
disadvantages of paper charts
- only be used by one person at a time
- easily misplaced from filing errors
- cannot be easily shared
advantages of electronic medical record
- accomplishes many tasks in one system
- decrease medical errors
- decrease time spent correcting things
- secure way to communicate with pt
wave scheduling
- three pts scheduled at same time
- seen in order they arrive
- one pt arriving late won’t disrupt schedule
modified wave scheduling
- two pts scheduled at same time with third arriving about 30 mins later
- time sequence continued throughout the day
double booking
- 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
info for scheduling appointment with established pt
- pt name
- date of birth
- reason for visit
- time provider will need for visit
- any day or time pt prefers
info for scheduling appointment with new pt
- demographic info (name, address, DOB, phone number, insurance, SSN, emergency contact)
- registration forms completed (notice of privacy practices, medical history form)
how long should pt wait in waiting room with effective scheduling
no more than 15 mins
what to do when pt doesn’t show up
- recorded in medical record
- may have to pay a fee
- may discharge pt if continued cancellations or missed appointments
automated call routing system
- offers pt option of canceling, confirming, or rescheduling appointments
- keeps track of what pts choose
steps for filing
- conditioning
- releasing
- indexing and coding
- sorting
- storing and filing
conditioning
- grouping related papers together
- removing paper clips and staples
- fixing damaged records
releasing
- marking form to be filed with mark of designated preference
indexing and coding
- determining where to place original record in the file
- if it needs to be cross-referenced in another section
sorting
- ordering papers in filing structure
- placing documents in specific groups
storing and filing
- securing documents permanently in the file
- ensure medical record documents do not become mispalced
alphabetic filing
- traditional system in provider’s offices
- most widely used
- arranged by last name, first name, middle initial
numeric filing
- 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
subject filing
- general correspondence using alphabetic or alphanumeric filing methods
- all correspondence dealing with particular subject is placed under specific tab
first step when deciding whether to purge, transfer, or retain a medical record
- determine if it’s active, inactive, or closed
how long do facilities preserve most medical records (including Medicare or Medicaid records)
minimum of 10 years
Health Insurance Portability and Accountability Act (HIPPA)
- does not require specific method for medical record disposal
what should you document when you destroy a medical record
- when
- how
- by whom
things in medical record
- lab reports
- radiology reports
- nurses notes
- medications
- flow sheets
- provider progress notes
- administrative forms
how are things filed in medical record
- chronological
- reverse chronological
SOMR
- source-oriented medical record
SOAP
- subjective
- objective
- assessment
- plan for treatment
CHEDDAR
- chief complaint
- history
- examination
- details
- drugs and dosages
- assessment
- return visit info
what must provider use system for to meet federal criteria to qualify for CMS incentives
- e-prescribing
- communicating with pts
- computerized provider order entry (CPOE): includes lab and radiology orders
encryption
when data is translated into code that requires the use of a password to unlock
security measures for electronic records
- passwords
- encryption
- firewalls
- antivirus programs
why is accurate documentation important
- ensures continuity of care among all healthcare providers
- functions as evidence in courts of law
- aid researchers in gathering statistical info
CPOE
- 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
how must requests for medical records be provided
in writing
where should the release of medical records be filed
in pt chart
who can present legal power of attorney to authorize them viewing pt medical records
the pts attorney
first step in check-in process
greeting pts
what should you do in the reception area at the end of each day
- sanitize chairs, counters, and door knobs
demographic info needed on registration form
- 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
two primary forms of identification during check-in process
- driver’s license or other ID
- insurance cards
when does pt sign consent to treat form
before seeing provider unless emergent situation
when is written informed consent required
- when invasive procedure or treatment will be performed
- any situation requiring in-depth understanding of treatment or procedure
implied consent
- minimally invasive procedure
- venipuncture, EKG
how to prepare for the day ahead
- print daily schedules
- answer messages from the night before
- ensure all rooms are stocked
copay
- specified sum of money based on pt insurance policy benefits
- due at time of service
coinsurance
- amount policyholder is responsible for
- just meet deductible before insurance will contribute
- typically 80/20 ratio
deductible
- specific amount pt must pay out of pocket before insurance pays
- usually reset after a year
explanation of benefits (EOB)
- provided to pt
- what services were paid, denied, or reduced in payment
remittance advice (RA)
- EOB sent to provider
- electronic fund transfer info or check for payment
advance beneficiary notice (ABN)
- Medicare pt signs when provider thinks Medicare won’t pay for service
- needs to be signed before service provided
- copy given to pt
federal insurance policies
- 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
private insurance policies
- 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
info needed to verify insurance coverage
- full name
- DOB
- policy number
- SSN
Federal truth in Lending Statement
- signed by pt
- arranges for payments from local organizations that last longer than 4 months
ICD-10-CM
- 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
ICD-10-PCS
- PCS: procedure coding system
- system comprised of medical classifications for procedural codes
- typically in hospitals
CPT codes and modifiers
- current procedural terminology codes
- document procedures and technical services
- all info in medical record must be correct for correct code to be documented
HCPCS
- 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
forms necessary to send out claims
- pt encounter form
- treatment or progress notes
- history and physical exam notes
- discharge summaries
two types of claims to submit for payment for services
- paper claim: manually filled out and mailed to insurance carrier, all uppercase, nothing handwritten
- electronic claim: generated electronically, processed through direct billing or clearinghouse
chart reviews
- 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
three factors in determining level of service within evaluation and management coding
- history: problem-focused, detailed, or comprehensive
- examination
- medical decision making
what is used to examine medical records or claims for accuracy and completeness
- auditing methods, processes, and sign-offs
referral
- document or form required by insurance companies
- used when provider wants to send pt to specialist
- documented in pt medical record
types of referrals and long processing takes
- regular: 3 to 10 business days
- urgent: 24 hrs
- stat: as soon as possible
what is included in a referral
- demographic info
- insurance info
- NPI
- diagnosis
- planned procedure or treatment
preauthorization
- 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
info needed to get prior authorization
- 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
precertification
- 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)
participating providers
- 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
account balance
- total balance on an account
- can be debit (negative) or credit (positive)
debit
amount owed
credit
monetary balance in individual’s favor
accounts receivable
amount owed to provider for services rendered
accounts payable
- debt incurred but not yet paid
assets
property of an individual or organization that is subject to payments for debts owed
liabilities
items that are debts
two types of billing methods
- manual
- computerized systems
computerized billing system
- software generates report for accounts according to last time payment was made
- determine which accounts are 30, 60, or 90 days old
manual billing system
- accounting forms, ledgers, receipts used on peg board system
- cumbersome and time-consuming
when is billing sent
before the 25th of each month
NSF
- nonsufficient funds
- check returned and medical office can charge additional fees to pt account
electronic fund transfers (EFT)
- 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
charge reconciliation
- 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
how often should you balance and obtain accounts receivable total
- once a month
- after posting all charges and payments
aging report
- 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
two primary reasons claims are denied and rejected
- technical errors
- insurance policy coverage issues
steps to appeal denial
- determine why claim was denied
- obtain and complete insurance company’s appeal document
- include letter from provider to give medical necessity
telephone etiquette
- speak clearly
- hold mouthpiece 1 in away from lips
- maintain confidentiality
network
two or more computer systems connected together
data field
location where data is stored within computer program
Electronic medical record (EMR)
- digital chart used within a facility
Electronic health record (EHR)
- includes EMR and other info to be used between facilities
what should you do in a fire or natural disaster
make sure all pts are evacuated and accounted for prior to exiting
responsibility of OSHA
- reduce workplace injuries, illnesses, and fatalities
- all facilities with more than 10 employees must have written emergency evacuation plan and reviewed annually
