MA145

Capture of insurance policy number is not an application of an EHR system?
1. Capture of past social history.
2. Capture of medication allergies.
3. The ability to send a prescription electronically.
Are all applications of an EHR system.
Practice management software?
1. Appointment scheduling
2. Charge capture
3. Collections
4. Reporting
The services that processes insurance claims is?
Clearing house
What type of function is submitting claims?
Administrative.
Master patient index?
Is what you will first access to determine if the patient has ever been seen at the hospital before, or whether you must register him/her for the first time.
How many digits are keyed when entering data on a claim for the date?
Eight digits ex: 08/012/2014
What kind of data is name, address and date of birth?
Demographics
Information that identifies the patient in anyway is known as ?
P.H.I. Protected Health Information
A unique identifier that is required on claim forms and identifies the care provider or group practice submitting the claim is the?
National Provider Identifier number.
Pre-certification?
When a PCP wants to if a patient’s managed care plan covers a particular surgical procedure.
Difference between an EMR and EHR?
Electronic medical records (EMRs) are a digital version of the paper charts in the clinician’s office. An EMR contains the medical and treatment history of the patients in one practice.

And

Electronic health records (EHRs) do all those things—and more. EHRs focus on the total health of the patient—going beyond standard clinical data collected in the provider’s office and inclusive of a broader view on a patient’s care.

Participating physicians receive …
80% of the allowable fee paid by Medicare.
When a policy holder signs this form it authorizes the insurance company to pay the provider directly
Assignment of benefits
What do the following plans have in common? Medicare, Medicaid, Tricare?
They are all government plans
An encounter form is also known as a ?
Superbill
There is an unwritten law of medical insurance that means “if a procedure is not _________, then, in the view of the payer, it was not done and should not be billed.
1. Legally sound.
2. Medical reviewed.
3. Reviewed by physician peer group
4. Documented
A ___________ agrees to to provide medical services to a payer’s policy holder according to the terms of the plan’s contract?
Participating Provider.
Medicare A
Hospice care, inpatient hospital stays
Medicare B
Dr. services, outpatient and preventative care
Medicare C
Medigap and Medicare Advantage, optional
Medicare D
Prescription Drug Coverage, optional.
Which of the following ensures that when patients have more than one policy, maximum appropriate benefits are paid?
Coordination of benefits guidelines.
Describe one of HIPAA goals?
Establish standards for keeping health care information safe.
Confirmation from an insurance company that a service or procedure is covered under a particular plan and is approved as medically necessary BEFORE service is rendered is called?
Preauthorization.
When looking up a diagnosis code you must first look in volume?
2
ICD-9 codes have how many digits?
3-5
Practice Management software?
Specialized computer software that performs administrative and billing procedures in the medical offices
Point of care?
Procedures that take place at the time of care, rather than at a remote location or after care is complete.
Code linkage?
Connecting the diagnostic code to the procedure code on the insurance claim so the procedure is justfied
Clearinghouse?
Service that assists in claims processing by standardized billing and performing error checks
Co-insurance?
Cost sharing requirement under a health insurance policy that stipulates the insured assumes a percentage of the costs of covered services.
Electronic Health Record?
Computerized medical record system that captures and stores data in electric form and can be transmitted to other health care locations
Clinical Decision Support?
Method of accessing current treatment options for a disease, through electronic or remote methods.
Co-pay?
The amount due from the patient at the time of the office visit; typically a requirement of managed care plans.
Interoperability?
Through a single database, many different functions can take place and information can be shared.
Birthday Rule?
Determines the primary care insurance plans when both parents cover a child.
Deductible?
An amount the insured must pay in a calendar or fiscal year before policy benefits begin.
Protected Health Information?
Any piece of identifying or clinical information about a patient.
Meaningful use?
Use of health information in a effective and efficient manner to improve patient care.
Checking a diagnostic code against a procedure code is referred to as?
Code linkage
Encounter form?
A form generated at the completion of an office visit, a portion of which details the patients diagnosis, procedures and services performed, and charge for each procedure/service.
Electronic claims submission?
Filing a healthcare claim using a computer rather than paper.
Speech recognition?
Technology that digitally transcribes spoken words.
Practice Management software?
Specialized computer software performs administrative and billing procedures in medical offices.
Demographics?
documented patient information such as age, sex, race
Point of care?
Procedures that take place at the time of care, rather than at a remote location or a at a point in time after care
Care provider?
Person, usually a physician, who performs healthcare services requiring specialized education and training
Clearninghouse?
Service that assists in claims processing by standardizing billing and performing error checks.
EHR/EMR software is more comprehensive than Practice Management software because it?
includes clinical documentation
PrimeSUITE
1. allows for ePescribing
2. has mobile applications.
3. assists in information exhange.
A patient is entered into the patient list?
Once
The process of moving a patient from appointment making through check-out is known as called?
Patient flow
Clinical documentation of a patient’s visit is known as the?
Progress note
An encounter form is also known as?
Superbill
A _____ is a form used to bill patient claims in a physician office?
CMS1500 form
Which illustrates clinical information collected through an EHR?
Plan of care
________ is not easily attained when using a manual record system?
Interoperability.
Vital signs?
Patient information such as blood pressure and respiratory rate.
Past medical history?
patient information that includes immunizations and allergies.
Social history?
patient information that includes information such as frequency of drinking and smoking.
review of systems?
Comprehensive inventory of patient symptoms such as headaches , vision, heart palpitations, swelling of joints, etc
Past surgical history?
Patient information that includes past procedures and who performed the procedures
Past family history?
Patient information that includes possibly inherited conditions.
An on screen item of data is known as?
A field
PrimeSUITE allows you to note discrepancies in the _____ box?
Details box
It is important to keep the design of of paper forms?
Logical
Which of the following, 1. family, 2. birth, 3. social, 4. surgical, is not a required patient history?
2. Birth
The following will benefit from thoroughly completed paper forms
1. Care providers
2. Patients
3. Receptionists
The patient’s ____ history could possibly help predict a future health condition?
Family
A patient’s vital signs are entered via PrimeSUITE’s ____ screen?
Facesheet
The following is an acceptable way of gathering a patient’s history:
Interview
Which piece of information might be included multiplies times on a form?
Allergies
What information should you see on all forms in a patient’s chart?
1. name
2. DOB
3. medical record number
A patient’s past surgical history includes the?
Approximate date of the procedure
For ease of completion, related information should be ___ on a form?
Adjacent
What does BMI stand for?
Body mass index
Which of the following would include a patient’s exercise regimen?
Social history
Any discrepancies in patient information need to be?
Documented
Administrative data?
Information, such as a patient’s gender and date of birth, that is required to be collected under HIPAA
Data Dictionary?
A list of correct definitions for a facility’s unique terms and jargon.
CMS-1500
The form used to submit insurance claims in a healthcare office
Library?
In terms of computer software, a comprehensive listing of related entities to choose from, such as ICD-10 codes