Practice Management & EMR

Question 1

Credentials

Answer 1

Login information to access software, such as username and password

Question 2

Practice management

Answer 2

Software used for administrative and billing tasks, such as scheduling appointments, generating reports, and billing insurance providers and patients

Question 3

Electronic health records

Answer 3

A platform that can be accessed, managed, and consulted across more than one health care organization; refers to the shared information from all clinicians involved in a patient’s care

Question 4

Electronic medical records

Answer 4

Used to record patient health information in a digital format that allows the provider to track a patient’s health over time, improving the quality of care

Question 5

Patient education

Answer 5

Application within an electronic health record that provides access to a comprehensive list of patient education material that is provided to educate or instruct a patient based on the patient’s condition and treatment options

Question 6

HIPAA

Answer 6

Health insurance portability and accountability act of 1996; United States legislation that assures patient privacy and security provisions for medical information

Question 7

Meaningful use

Answer 7

A set of specified objectives that medical providers must meet in order to prove that they are using their ehr as an effective tool in their practice

1) using certified EHR technology to improve quality, safety, efficiency, and reduce disparities
2) Engaging patients and family
3) improving care coordination, and population and public health
4) maintaining privacy and security of patient health information

Question 8

Reference sheet

Answer 8

Shows all patients scheduled for an office visit for a specified time period

Question 9

Secondary insurance

Answer 9

When a patient has more than one insurance coverage, the secondary is the one that pays after the primary has paid its portion, according to the benefits available under the secondary plan

Question 10

Patient portal

Answer 10

A secure online website that provides patients with 24 hour access to their medical information; details on the office visits, procedures, or medications; communication with staff and providers; methods to request or schedule appointments online; or other types of patient interaction with the clinic through an internet connection

Question 11

Encounter form

Answer 11

Also known as superbill , a charge ticket, or visit/ fee slip; contains all of the information insurance companies require in order to consider a claim for payment

Question 12

Remittance advice

Answer 12

Aka explanation of benefits. A document that provides details on claims billed to the insurance, and how the claims were paid, including information on allowables, deductibles, adjustments, and net payment. May be accompanied by a payment in the form of a check or may refer to an electronic funds transfer.

Question 13

Medical care

Answer 13

Identification of disease and the provision of care and treatment to persons who are sick, injured, or concerned about their health status

Question 14

Health care

Answer 14

Expands the definition of medical care to include preventive services, which are designed to help individuals avoid health and injury problems

Question 15

Health care insurance

Answer 15

A contract between a policyholder and a third party payer or government health program to reimburse the policyholder for all or a portion of the cost of medically necessary preventive care provided by health care professionals

Question 16

Policyholder

Answer 16

A person who signs a contract with a health insurance company and owns the insurance policy

Question 17

Third party payer

Answer 17

A health insurance company that provides coverage

Question 18

Payer mix

Answer 18

Different types of health insurance payments that are reimbursement

Question 19

Group health insurance

Answer 19

Health insurance coverage subsidized by employers and other organizations

Question 20

Individual health insurance

Answer 20

Private health insurance policy purchased by individuals or families who do not have access to group health insurance

Question 21

Public health insurance

Answer 21

Federal and state health programs (Medicaid, Medicare, chip, Tricare)

Question 22

Single payer system

Answer 22

Centralized health care system adopted by some western nations (Canada) and funded by taxes

Question 23

Socialized medicine

Answer 23

A single payer system in which the government owns and operates healthcare facilities and providers (Finland, Great Britain)

Question 24

Universal health insurance

Answer 24

The goal of providing every individual with access to health coverage, regardless of the system implemented to achieve that goal (Obamacare)

Question 25

Federal employer’s liability act

Answer 25

Legislation that protects and compensates railroad workers who are injured on the job

Question 26

Federal employees compensation act

Answer 26

Provides civilian employees of the federal government with medical care, survivors benefits, and compensation for lost wages

Question 27

Hill-Burton Act

Answer 27

Provided federal grants for modernizing hospitals that had become obsolete because of a lack of capital investment during the Great Depression and World War Two. In return for federal funds, facilities were required to provide services free or at reduced rates to patients unable to pay for care

Question 28

Third party administrators

Answer 28

Administer health care plans and process claims, thus serving as a system of checks and balances for labor and management

Question 29

World Health Organization

Answer 29

Developed the ICD (International classification of diseases), a classification system used to collect data for statistical purposes

Question 30

Major medical insurance

Answer 30

Provided coverage for catastrophic or prolonged illnesses and injuries

Question 31

Deductible

Answer 31

The amount for which the patient is financially responsible before an insurance policy provides payment

Question 32

Lifetime maximum

Answer 32

The maximum benefits payable to a health plan participant

Question 33

Medicare

Answer 33

Provides health care services to Americans over the age of 65

Question 34

Medicaid

Answer 34

A cost sharing program between the federal and state governments to provide health care services to low income Americans

Question 35

Civilian health and medical program - uniformed services

Answer 35

Designed as a benefit for dependents of personnel serving in the armed forces (Tricare)

Question 36

Cpt

Answer 36

Current procedural terminology
Developed by the American medical association. Includes changes that correspond to significant updates in medical technology and practice

Question 37

Self insured employer-sponsored group health plans

Answer 37

Large employers are allowed to assume the financial risk for providing health care benefits to employees

Question 38

OSHA
Occupational Safety and Health Administration

Answer 38

Designed to protect all employees against injuries from occupational hazards in the workplace

Question 39

Civilian health and medical program of department of veterans affairs

Champva

Answer 39

Provide health care benefits for dependents of veterans rated as 100 percent permanently and totally disabled as a result of service connected conditions, veterans who died as a result of service connected conditions, and veterans who died on duty with less than 30 days of active service

Question 40

Employee retirement income security act of 1974

Answer 40

Mandated reporting and disclosure requirements for group life and health plans, permitted large employers to self insure employee health care benefits, and exempted large employers from taxes on health care premiums

Question 41

Copay

Answer 41

A provision in an insurance policy that requires the policyholder to pay a specified dollar amount to a health care provider for each visit or medical service received

Question 42

Coinsurance

Answer 42

The percentage of costs a patient shares with the health plan

Question 43

CMS

Answer 43

Centers for Medicaid and Medicare services

Question 44

Medicare advantage plan

Answer 44

A type of medical plan that replaces original Medicare and provides all part a and part b benefits. Silver sneakers, prescription drugs, fit program, hmos, ppos, fee for service plans, Medicare medical savings account plans, and special needs plans are all available.

Question 45

Dependent

Answer 45

Eligibility refers to who can be added onto an insurance plan where the policyholder is someone else. Typically spouses and children

Question 46

New patient

Answer 46

An individual who has not received services from the provider, or from an associate provider of the same specialty who belongs to the same group practice, within the past three years