Thursday - Forms & Revenue Cycle Flashcards
What is the Coordination of Benefits (COB)
Addresses the order of insurance coverage of claims when a patient has more than one third party payer. It determines what insurance plan gets billed first.
What is assignment of benefits (AOB)
Form that authorizes health insurance benefits to be sent directly to providers.
What is the Notice of Privacy Practice (NPP)
Signed by patient notifying a patient of how the health organization may use personal shared information and it includes health privacy practices
What is advance directive
Document that spells out what kind of treatment a patient wants in the event that he can’t speak for himself. Also known as living will
What is account payable (A/P)
Accounts payable refers to the money that the healthcare facility owes others
What is an account payable ledger
The ledger shows the past transactions between a company and its suppliers.
It contains amounts owed, dates, and other details relevant to the repayment of short term liabilities
What is account receivable (A/R)
Money that is expected but has not yet been received. Money owed to the facility
What is advanced beneficiary notice (ABN)
Form provided to a patient if a provider believes that a service may be declined because Medicare might consider it unnecessary
what is non sufficient funds
NSF checks occur when a patient pays with a check without having sufficient funds in the bank to cover payment
Which of the following parties is financially responsible for payment?
Guarantor
What is utilization management?
Ensures that patients are getting right quality care
What is Utilization Review
Reviews individual cases to ensure that medical care services are medically necessary
What is remittance advice (RA)
A document sent by the insurance company to the provider explaining the allowed charge amount, the amount reimbursement for services, and the patient’s financial responsibilities.
What is explanation of benefits (EOB)
A document sent by the insurance company to the patient explaining that allowed charge amount, the amount, reimbursed for services, and the patient’s financial responsibility
What is the CMS-1500 Form
The standard insurance claim form used for all government and most commercial insurance companies
What is practice management software (PMS)
Sometimes called medical practice management (MPM) it is used to run the day-to-day business side of the ambulatory care facility.
Interfaces with the EHR software
Which document provides detailed information about charges, payments, and remaining amounts owed to a provider
Account Receivable Ledger
What protects against embezzlement and wrongdoing
Bonding
Health history form
Form that asks patients to list any illnesses or surgeries they have had, family history, medications taken, chronic health issues, allergies, and other physicians they consulted
MSDS (Material Safety Data Sheet)
Data concerning the safe use of chemical disinfectants; “right to know” ;black and yellow notebook.
When a patient request a copy of his medical records the CMAA should first Request the patient to sign
Release of medical records
OSHA Form 301
Used to report an incident to OSHA
UB-04
Submit claim for hospital services
Avoids overlapping payment
Coordination of benefits
Ensure accurate accounting
Day Sheet
A formal request for reconsideration of a denied claim
A claim appeal
