Medical Office Management & Technology Ch. 1

SHARE
sense peoples needs, help each other, acknowledge peoples feelings, respect the dignity & privacy of everyone, explain what’s happening
goal of medical office is:
provide exceptional, accessible healthcare
adjudication
determination by a third party of its financial obligations after applying the patients health insurance benefits to a claim.
what happens before appointment is made?
determination of financial responsibility
how many years does the patient have to be an established patient?
3
what is the practice management (PM) system?
software that deals with the day-to-day operations of a medical practice. Captures demographics, appointments, lists of insurance payers, billing tasks. connected to the EHR system
what is a source document?
document in which data collected for a clinical trial is first recorded.
what is a physician extender?
not a physician but performs activities typically performed by a physician. nurse, nurse practioner
What does SOAP stand for?
subjective, objective, assessment, plan
subjective
(history) when samples are taken, or patients gives medical history
objective
(exam) when physician examines patient by using medical knowledge
assessment
when physician assesses the condition that needs to be addressed
plan
when physician determines a plan of treatment
the physician documents the clinical aspect of the patient encounter in what is called a ____________ order.
SOAP
CPT is:
current procedural terminology which is a coding system by the AMA identifying codes for medical services and procedures performed by physicians and other qualified practioners. 5 digit codes standardized description of surgeries or other procedures
in order to select an appropriate CPT code medical necessity must be demonstrated by one or more codes from the _____________________.
ICD (international classification of diseases)
ICD
used to code and classify health conditions, reason for encounters, inpatient hospital procedures, other health related information
superbill
itemized form reflecting rendered services, (used in place of a coder) main data source for creation of health care claim which is submitted to payers for reimbursement
claim
Like a bill. It’s created by the PM system which is a standardized document (CMS 1500) which contains all necessary information submitted to a third-party payer in order for the practitioner to be reimbursed for eligible health services when a patients has insurance
clearinghouse
service where claims are checked for accuracy, then routes the claims to the appropriate payer in batches. scrubbed and formatted in real time specific to each insurance company regardless of software used
remittance advice (RA)
sent by payer; notice of payments paid or denied sent to providers, billers, and suppliers after claim has been received or processed
explanation of benefits
part of RA that details any reasons for denied charges, reduced payments, patient responsibility, physician responsibility, or automatically transmitted by a second payer. also mailed to patients
ad hoc
as needed reports used by the practice
What is the person called who is at the highest level of nonclinical management in a medical office?
practice administrator/practice manager/office manager
RHIT
registered health information technician trained and certified by exam to be a licensed
RHIA
registered health information administrator who design and manage medical information systems, insuring accurate record keeping while meeting state and federal requirements for confidentiality
encoder
software that is interfaced or integrated with the practice management (PM) software that links key terms with codes. insurance specialists check this for inconsistencies
revenue cycle
the process of reimbursement from scheduled appt to final payment
CMA
certified medical assistant trained in both clinical and office administrative positions
PQRI
physician quality reporting initiative from the tax relief and health care act from 2006. reporting program that encourages individual eligible professionals (EPs) and group practices to report information on the quality of care to Medicare, by giving incentive payment
CMS
center for medicare and Medicaid services from the federal department of health & human services
federal register
daily publication of rules, proposed rules, and notices from the federal government