WEEK THIRTEEN Flashcards
purchase requisitions
formal request from staff for supplies/equipement
purchase order
form that authorizes a purchase
most common scheduling
computerized scheduling
Applying the matrix
- block off times unavailable
- appointments can be group by provider, appt types, or resources(surgery room/lab)
stream scheduling (time specific scheduling)
- patients scheduled for specific times
- at regular intervals
wave scheduling
- flexibility for people who are late and/or require more or less time
- three patients are scheduled at the same time at the top of the hour
Modified Wave Scheduling
two patients scheduled at the top of the hour and a 3rd scheduled 30 mins later
Double booking scheduling
- two patients scheduled at the same time
- work in patients with acute illness
- creates delays for patients and providers
cluster/categorized scheduling
- grouping patients with similar exam types, conditions, or treatments, within a certain time block during the day (ultrasounds)
established patient
person who has received professional services from a physician within a previous 3 years
F/U duration
- follow up appt: 20-30 mins
New patients will be required to fill out
- notice of privacy
- medical history
- HIPPA release forms
NP duration
new patient: 45- 1hr
S/R duration
suture removal: 10 - 20 min
CPE duration
Complete physical exam 30-60 mins
CAN
cancellation: 0 mins
NS duration
No show: 0 mins
P & P
Pelvic exam and Pap Smear: 15-30 mins
Superbill or Encounter
Created when the medical assistant and physician see the patient in person (billing purposes)
comprehensive appt
new or established patient for a specified complaint at highest coding level, multiple complaints, injuries, or worsening chronic conditions
most common size of envelopes
no. 10
formal business stationary
- name and address
- associates
- phone and fax numbers
- website info and e-mail
most used outgoing mail
first class
most secure outgoing mail
registered
TDD
Telecommunication device for the deaf
5 C’s of effective communication
- completeness
- consideration
- conciseness
- concreteness
- clarity
Five basic steps for filing
- conditioning
- releasing
- indexing & coding
- sorting
- filing
electronic medical record
digital charts to be used within a facility
electronic health record
includes EMR and other info used between facilities
Personal health record
- access controlled solely by patient
release of information form
- also known as HIPAA form
- allows practice to share patient info
consent to treat form
- gives the physician permission to treat a child
meaningful use
guidelines imposed by the Health Information Technology for Economic and Clinical Health (HITECH) ACT in 2009
- improves quality, safety, efficiency, and reduce health disparities
deductible
patient must pay out of pocket before insurance begins paying
coinsurance
insurance company share the cost of service
copayment
amount paid at the time of service
assignments of benefits
form signed by the patient to allow the provider to be paid directly by the insurance company
participating provider
providers that agree to write off the difference between that amount charged and the allowed amount by the insurance company
allowed amount
the maximum amount the insurance company will pay for a service for product
advanced beneficiary notice
patient being responsible for payment because Medicare will not cover the service
explanation of benefit
statement from insurance company to patient outlining amounts billed
preauthorization
contacting the insurance plan to see if a procedure is a covered
medicare
cover patient 65 and older
medicare part A
hospitalization
medicare part B
routine medical office visits and outpatient services
medicare part C
optional additional coverage offered by private companies approved by Medicare
medicare part D
medications
medicaid
covers low income and mentally indigent
tricare
covers military personnel and dependants
CHAMPVA
covers spouse and dependent children of veterans who passed away
Workers Compensation
covers workers against lost wages due to accidents on the job
Children’s Health Insurance Program (CHIP)
provides low-cost health coverage to children who’s in a household that earn too much money
managed care health plans
plans that provide healthcare for payments
HMO
- contracts with providers and hospitals to provide preventative and acute care
- requires referrals, PCP, preauthorization
PPO
- no referrals needed
fee- for-service
amount charged for services is controlled by the insurance carrier
pay-for-performance
compensates providers only if certain measures are met for quality and efficiency
capitation
- patients are assigned a per month payment based on age, race, sex, lifestyle, medical history
coordination of benefits
- prevents duplication of payment
- primary insurance plan pays first
- secondary plan pays the deductible and copayment after the processed their claim
