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Core Training > Week 1 > Flashcards

Week 1 Flashcards

0
Q

Mission statement

A

Create value for organizations in healthcare industry thru innovative business solutions built on superior technology enhanced with excellent service

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1
Q

3 adjectives to describe quadax

A

Medical billing, technology, service

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2
Q

4 values

A

Dependability, integrity, respect, teamwork

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3
Q

6 business units

A

Managed a/r, administration, reimbursement support, itis, network services, edi

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4
Q

Founding year

A

1973

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5
Q

First quadax client

A

Ohio medicaid

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6
Q

First quadax function

A

Data entry with ibm punch cards

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7
Q

3 benefits of being privately held

A

Flexibility, agility, quick response to change

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8
Q

7 office locations

A

Strongsville, middleburg, columbus, norwalk, beachwood, youngstown, GA

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9
Q

Harp stands for?

A

Healthcare a/r processor

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10
Q

2 harp models

A

Partner (share work), manager (quadax does it all)

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11
Q

Pas stands for?

A

Patient advocacy software

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12
Q

3 functions of pas

A

Pre-billing, medical records and appeals

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13
Q

Edi stands for?

A

Electronic data interchange

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14
Q

Who is xpeditors biggest client?

A

Harp

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15
Q

Define clearinghouse

A

Facilitator of transactions between provider and payer, used for faster reimbursement and accuracy

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16
Q

Csc

A

Client support center; xpeditor

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17
Q

Quick

A

Quadax internal check; formatting claims

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18
Q

ecm

A

Enterprise content management; onbase

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19
Q

Who developed onbase?

A

Hyland

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20
Q

How long does harp implementation take?

A

90 days

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21
Q

3 levels of harp database

A

Software (shared by all), virtual (shared by some), client (individual)

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22
Q

Purpose of medical billing

A

Get claim to insurance as quickly and accurately as possible for max reimbursement

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23
Q

12 Steps in the journey

A

Encounter, superbill, coding, pre-billing, ticket, claim generation, xpeditor, payer edits, adjudication, remittance, insurance followup, statement

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24
Q

2 parts of demographic information

A

Patient info, insurance

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25
Q

ELEL and RERE

A

Electronic eligibility and review response; used in pas to make sure insurance will accept procedure

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26
Q

What makes up a ticket?

A

Demographics from drs and charge info from crs, united by common account number

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27
Q

Cms1500

A

Outpatient form

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28
Q

Ub04

A

Inpatient form

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29
Q

837

A

Electronic form created by xpeditor to send to insurance

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30
Q

Emdeon

A

Post office in the sky; clearinghouse for small payers

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31
Q

Payer edits

A

Insurance company checks patient id, codes, and eligibility

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32
Q

Adjudication

A

Decide what to pay - all, none, line item, or deductible required

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33
Q

835

A

Electronic remittance sending money back thru clearinghouse for payment

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34
Q

Eft

A

Electronic funds transfer

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35
Q

Era

A

Electronic remittance advice

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36
Q

Lockbox

A

Where money and other correspondences from insurance company goes before being posted in system

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37
Q

Insurance follow up

A

Investigation & resubmit of denied claims

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38
Q

Expected growth in healthcare industry in next 10 years

A

10.8%

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39
Q

Leading cause of death in 1900s

A

Gastrointestinal infection

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40
Q

8 Causes of improved care/prolonged life

A

Infection control, less invasive surgery, gene therapy, preventive testing, specialized equipment, robotics, telemedicine, electronic charting

41
Q

A/r

A

Accounts receivable, money due to provider

42
Q

Accounts payable

A

Money due from provider

43
Q

8 Modern medical challenges

A

Controlling expenses, occupancy rates, coordinating with insurance, decreased income, hipaa, jcaho, avoiding duplication, staffing

44
Q

Quadaxs largest client base

A

Labs and hospitals

45
Q

2 types of insurance

A

Individual and group

46
Q

Traditional insurance plan

A

Most flexible, choose any doctor, deductible & co-insurance

47
Q

Ppo

A

Preferred provider organization, any provider but pay more out of network, no pcp

48
Q

Hmo

A

Health maintenance organization, pcp required, in network only, authorizations required, no deductiblr

49
Q

Pos

A

Point of service, combo of ppo and hmo, pcp oversees most care

50
Q

Capitation

A

Provider paid a set amount per billing cycle to see x number of patients

51
Q

Dmg

A

Delegated medical group, aka ipa, california plan based on capitation and preventive medicine

52
Q

Ipa

A

Independent practice organization, aka dmg

53
Q

Hra

A

Health reimbursement account, employer pays

54
Q

Hsa

A

Health savings account, employee pays

55
Q

Medicare

A

Federal plan for elderly, disabled & end stage renal

56
Q

Part a

A

Inpatient

57
Q

Part b

A

Outpatient

58
Q

Part c

A

Advantage replacement; commercial with no secondary allowed

59
Q

Part d

A

Prescriptions

60
Q

Medigap

A

Supplementary insurance for medicare, commercial

61
Q

Rrmc

A

Railroad medicare

62
Q

Umw

A

United mine workers

63
Q

Tricare

A

Active and retired military

64
Q

Champva

A

Relatives of permanently disabled veterans

65
Q

Medicaid

A

Eligibility determined monthly based on income, can supplement medicare, state funded, patient not responsible for balance

66
Q

Workers comp

A

Occupational illness and accidents, pre-auth required, patient not responsible for balance

67
Q

Self funded

A

Employer pays third party admin, keeps premiums to pay claims, use stop loss insurance

68
Q

Assignment of benefits

A

Patient agrees to let insurance pay provider directly

69
Q

Coordination of benefits

A

Order of insurance (1st, 2nd, etc)

70
Q

Co-insurance

A

Percentage required from patient

71
Q

Guarantor

A

Person responsible for bill, can be dependent if they are over 18

72
Q

Pre-authorization

A

Is service covered and medically necessary?

73
Q

Pre-certification

A

Is treatment covered?

74
Q

Pre-determination

A

Maximum allowable amt

75
Q

Ucr

A

Usual customary rate, guideline for payment

76
Q

Blue card local vs home plan

A

Local is where lab is located, home is listed on patient insurance card

77
Q

Where is blue card claim sent?

A

State where specimen was collected

78
Q

Who maintains cpt and icd?

A

World health organization

79
Q

5 uses of icd and cpt coding

A

Analysis of diseases and therapies, reimbursement, decision support, outbreaks, fraud

80
Q

Icd

A

International classification of diease

81
Q

2 volumes of icd

A

Tabular by body system, alphabetical

82
Q

Steps in icd coding

A

Determine reason for visit, use alphabetical index, use tabular index

83
Q

V code

A

Visits without a procedure, primary or standalone

84
Q

E code

A

External cause of injury or poisoning, cannot be primary or stanalone

85
Q

Cpt

A

Current procedural technology, 5 digits with 2 possible modifiers

86
Q

6 sections of cpt manual

A

Eval and mgmt, anesthesia, surgery, radiology, path/lab, medicine

87
Q

3steps in cpt coding

A

Determine procedures, id codes, determine need for modifiers

88
Q

Cpt tiers

A

Tier 1 is frequently used, tier 2 is infrequent

89
Q

Modifier 22

A

Greater than listed

90
Q

Modifier 25

A

Spearately identifiable procedures

91
Q

Modifier 26

A

Professional component

92
Q

Modifier tc

A

Technical component

93
Q

Modifier 50

A

Bilateral

94
Q

Modifier 52

A

Reduced service

95
Q

Modifier 59

A

Multiple times in a day

96
Q

Modifier 90

A

Outside lab

97
Q

Modifier 91

A

Repeat procedure

98
Q

Modifier ga

A

Abn signed

99
Q

Abn

A

Advanced beneficiary notice, patient notified they’ll be responsible for balance

100
Q

Pqrameter

A

Determines rules for how data is handled in harp

101
Q

Roster

A

Group of individuals from same facility with same charge grouped for easier billing

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