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Core Training > Week 2 > Flashcards

Week 2 Flashcards

0
Q

How do documents arrive in onbase? (3 ways)

A

Electronic, fax, hardcopy

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1
Q

Onbase

A

Document storage and retrieval

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2
Q

ObServer

A

Used by quadax and clients that dont pay for their own database

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3
Q

3 ways to search for a document in onbase

A

Group, type, keyword

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4
Q

Indexing

A

Assigning keywords to document

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5
Q

Wildcards (2 types)

A
  • multiple characters

? One character

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6
Q

How to display multiple search fields in onbase

A

F6 or double click

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7
Q

shortcut key in onbase

A

Alt

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8
Q

Which page in harp and pas do you access onbase from?

A

Related tasks & journal

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9
Q

Remittance

A

Result of payer claim processing

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10
Q

Allowed amount

A

Payer fee schedule

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11
Q

Filing limit

A

Maximum time from service to filing

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12
Q

5010

A

Claim transaction standards to go along with hipaa

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13
Q

Requisition

A

How lab orders and tracks a test

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14
Q

Accession

A

How lab tracks individual tests

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15
Q

Front end order entry system

A

Software that orders tests and receives results electronically

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16
Q

Ncd/lcd edits

A

National/local coverage determinations; medicare requires specific icd9 codes

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17
Q

Independent reference lab

A

Unique tax id & address
Direct contract
Cms1500

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18
Q

Hospital outreach lab

A

Hospital id and address
Hospital contract
Ub04

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19
Q

Lab network

A

Multiple members with own ids and addresses

Networked to get insurance contracts

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20
Q

Pathology lab

A

Unique tax id and pay to address

Cms1500

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21
Q

Esoteric/genetic lab

A

Venture capital funded

Highly specialized tests

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22
Q

New client implementation (5 steps)

A 
12 week implementation
Weekly conference
Interface dev
Harp database dev
Policies and procedures
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23
Q

Fee for service billing

A

Goes directly to payer

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24
Q

Roster billing

A

Goes to client, contract between lab and provider, billed on invoice monthly

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25
Q

6 benefits of quadax billing

A 
Carves out a/r
Efficient for low volume
Low charge
Expertise with labs
Tech/service org
Reporting options
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26
Q

Human genome project

A

Total genetic info in human chromosomes, 20k genes, sequencing took 6-8 years and $1 billion

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27
Q

4 Benefits of human genome mapping

A

Improved genetic testing, birth defect id, customized therapy, dna repair

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28
Q

Genetics

A

Study of inheritance

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29
Q

Dna

A

Inherited from parents, genetic info for all living cells

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30
Q

Gene

A

Unit of heredity passed through chromosomes to offspring

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31
Q

Genetic mutation

A

Permanent change in dna sequence - inherited or acquired

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32
Q

Polyploidy

A

Extra copy of every chromosome

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33
Q

Trisonomy

A

Three copies of a chromosome

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34
Q

Monosomy

A

Entire chromosome missing

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35
Q

Autosomal recessive gene

A

2 copies needed (one from each parent)

36
Q

Autosomal dominant gene

A

1 copy from 1 parent needed

37
Q

Genomics

A

Study of all genes and interactions

38
Q

Genomic testing

A

How genes affect development of a condition

39
Q

Cancer definition

A

Disease caused by uncontrollable division of abnormal cells, always named for place of origin

40
Q

Metastasis

41
Q

Micrometastasis

A

Spread of cells too small to be detected

42
Q

Sentinel lymph node

A

First nodes that cancer filters through, biopsy can be used to determine metastasis status

43
Q

Cancer stages

A

Used to describe extent (size of tumor, metastasis level)

44
Q

Lymphoma

A

Cancer of lymph nodes

45
Q

Sarcoma

A

Cancer of connective tissues

46
Q

Leukemia

A

Cancer of blood

47
Q

Carcinoma

A

Cancer of skin or tissue covering organs

48
Q

Orphan cancer

A

Affects small portion of population

49
Q

Tumor markers (5)

A 
Her2 - breast or ovarian
Estrogen
Progesterone
Psa - prostate
Egfr - lung
50
Q

Standard of care

A

Treatment based on best practices (works for majority of patients)

51
Q

Neoadjuvant

A

Before primary treatment

52
Q

Adjuvant

A

After primary treatment

53
Q

Chemotherapy

A

Toxic drugs, systemic

54
Q

Radiation

A

Systemic, x-rays

55
Q

Targeted therapy

A

Toxic drugs locally

56
Q

Immunotherapy

A

Use of immune system, aka biotherapy

57
Q

Hormone therapy

A

Drugs to suppress hormone production (reproductive cancers)

58
Q

6 results of ineffective treatment

A

Tumor progression, accumulated toxicity, side effects, cross resistance, decreased effectiveness, lower quality of life

59
Q

5 features of pas

A

Hijar - highly customizeable, integration with harp, journal, automated workflow, robust reporting system

60
Q

6 components of pas

A

Abcpop - appeal, benefit investigation, claim processing, prior auth, ordering physician, patient responsibility

61
Q

Define workflow

A

Reimbursement steps broken down to event/tasks on work lists

62
Q

Sop

A

Standard operating procedures, given by client as instructions to work a list

63
Q

4 pages of pas

A

Patient lookup, journal, view/update patient, view/update insurance

64
Q

3 parts of journal

A

Case info, insurance info, journal

65
Q

Work list status

A

Yellow - priority, white - open, gray - wait, red - hold

Grayed out - wait, bold - priority

66
Q

Entity comments

A

Indicated with orange text

67
Q

Red on insurance plan

A

Preclaim requirement exists

68
Q

red on status date

A

Someone else is working the case

69
Q

Event task relationship codes

A

W - work list created or updated
S - case status updated
W/s- both w and s
U - work list updated but not created if does not already exist

70
Q

Color letter boxes

A

Quick clue as to test being performed

71
Q

Load file

A

Demo and charges, as well as any other documents, are passed from client to quadax

72
Q

Data verification

A

Load file cross referenced from docs sent to onbase

73
Q

L06

A

Unbillable insurance, must be updated to correct insurance

74
Q

Dvmi

A

Data verification missing info work list, indicates client contact required (quadax places on priority, journal note to say whats needed, client responds and puts back to open status)

75
Q

Benefit investigation

A

3 steps - pending bi, patient notification of bi, md notification of bi

76
Q

Pending bi

A

Outsourced call to insurance is first step of bi

77
Q

Patient notification of bi

A

Quadax calls patient to review finances and assistance

78
Q

Md notification of bi

A

Call or fax to doctor to tell results of bi

79
Q

4 bi options

A

No bi
Do bi, proceed immediately with test
Do bi, hold for approval
Hold pending patient out of pocket expense (prostate only)

80
Q

Electronic eligibility

A

Elel, ansi 270
Sent to payer to confirm eligibility
Worked automatically by xpeditor

81
Q

Review response

A

Rere, ansi 271
Response from insurance after elel, posted automatically to journal
Completes automatically unless trigger requires intervention

82
Q

Manual verification of insurance

A

Performed after test is done for clients that dont use bi

83
Q

4 pre-claim requirements

A

Prior auth, somn, medical records, pcp referral

84
Q

Prior authorization

A

Approval prior to test, does not guarantee payment

85
Q

Somn

A

Statement of medical necessity, checkbox form filled out by physician

86
Q

Medical records

A

Documentation of medical history that indicates medical necessity

87
Q

Pcp referral

A

Referring physician, used for hmo plans

Core Training (4 decks)

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