NHA administrative assisiting Flashcards
type of scheduling that allows 3 people to be booked at the same time and be attended in order of arrival
- 1 patient being late does not interrupt providers schedule
wave scheduling
type of scheduling where 2 patients are schedules at the same time to see the same provider
double-booking
this notice describes how a patients medical info may be used or disclosed+ how to access
notice of privacy practices
this system allows patients to cancel, confirm, or reschedule an appointment
automated call routing
SOAP method to document on progress sheet
S- subjective (chief complaint-what patient says)
O-objective(clinical indication-vital signs)
A- assessment/ medical diagnosis
P-plan for treatment
electronic medical record system function that allows providers to digitally order lab and radiology testign, treatments, referrals, and prescriptions
computerized physician order entry (CPOE)
what are some parts of a patients demographic info
- full name
- dob
- address
- insurance
- marital status
- job
- social security
provided to the patient by the insurance company as a statement detailing what services were paid, denied, or reduced in payment
explanation of benefits (EOB)
explanation of benefits sent to the provider from the insurance company
remittance advice (RA)
a form a Medicare patient will sign when they think Medicare might not pay for a specific service or item
advance beneficiary notice (ABN)
allows specific reporting of diseases and newly recognized conditions, symptoms, injuries, etc
- 3 to 7 letters used
ICD- 10- CM
-International Classification of Diseases
system comprised of medical classifications for procedural codes used in inpatient settings (w/in hospitals) that record various treatments and testing
ICD-10-PCS
- procedure coding system (PCS)
INPATIENT
used to document procedures and technical services based on services by providers in outpatient settings
- OUTPATIENT
CPT codes
- current procedural terminology
group of codes and descriptions represent procedures, supplies, products, and services not listed in CPT code
HCPCS
- healthcare common procedure coding system
used to request payment from health insurance payers, like Medicare, after a patient has been treated
- claim is sent to the insurance company for reimbursement of services
CMS 1500
referrals should only be submitted after the approval of ____ and authorization of the _________- has been obtained
the provider
insurance company
provider obtains permission to perform certain services or refers patient to specialist
preauthorization
A decision by your health insurer or plan that a procedure when you are hospitalized is medically necessary.
precertification
amount owed to the provider for services rendered
accounts receiveable
if a check is returned to the medical office for nonsufficient funds, what is done
medical office has the right to charge additional fees to the patients account
includes EMR and other info to be used between facilities
EHR
method of filing where a new report is laid on top of an older report
shingling
process of moving active files to an inactive status
purging
describes the unlawful act of billing services at a higher rate than contracted to receive a larger reimbursement from a third-party payer
upcoding
provides info regarding chemicals used in a medical facility
SDS- safety data sheets
when MA receives instruction from doctor to refer a patient to a derm, what action do you take first
complete a patient referral form
when a duplicate payment is given for services, what happens
credit balance is added to patients account
the difference between what your physician billed your insurance company and what the insurance company has paid. _____________ are not billed to the patient; instead, they are written off by the health care provider
insurance disallowance
a complete listing of fees used by Medicare to pay doctors or other providers/suppliers
fee schedule
collab of physicians and health care staff whose goal is to reestablish the cost and quality of health care
- patients are not directly involved in this process
ACO
accountable care org
provide patients with in-home services by health professionals to minimize effects of disabilities or diseases and to restore patients overall health
home health agency
maximum reimbursement a third party will provide for a particular procedure or service
allowable amount
policy where insurance and policyholder share the cost of covered services in a specific ratio, like 80:20
coinsurance
list of charges for procedures and services performed at the providers office
fee schedule
