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Chapters 1-5
Medical Administrative Practices
| Question | Answer |
|---|---|
| What is the 1st step in the billing cycle? | Pre-register Patients |
| What is the 2nd step in the billing cycle? | Establish Financial Responsibility |
| What is the 3rd step in the billing cycle? | Check In Patients |
| What is the 4th step in the billing cycle? | Check Out Patients |
| What is the 5th step in the billing cycle? | Review Coding Compliance |
| What is the 6th step in the billing cycle? | Check Billing Compliance |
| What is the 7th step in the billing cycle? | Prepare and Transmit Claims |
| What is the 8th step in the billing cycle? | Monitor Payer Adjudication |
| What is the 9th step in the billing cycle? | Generate Patient Statements |
| What is the 10th step in the billing cycle? | Follow Up Patient Payments and Handle Collections |
| What are the responsibilities of Step 1 in the billing cycle? | Collect name, contact information, insurance information, determine reason for visit and whether the patient is new or established. |
| What are the responsibilities of Step 2 in the billing cycle? | Find out if the patient has insurance and what percentage they will pay and what will be paid by the patient. |
| What are the responsibilities of Step 3 in the billing cycle? | Patient fills out a Patient Information Form which contains personal, employment, and insurance information. Their identity is identified and copay is collected. |
| What are the responsibilities of Step 4 in the billing cycle? | Documentation of the encounter is recorded on a medical record (chart). The physician gives a diagnosis and performs procedures which are translated into a standardized code that goes on an encounter form or superbill. |
| What are the responsibilities of Step 5 in the billing cycle? | Codes are assigned and should be logically connected so the medical necessity of the charges is clear to the insurance company. |
| What are the responsibilities of Step 6 in the billing cycle? | Analyze what can be billed on health care claims. |
| What are the responsibilities of Step 7 in the billing cycle? | Gather all information to send a claimto insurance company to receive payment. |
| What are the responsibilities of Step 8 in the billing cycle? | Monitor the adjudication process that the insurance company uses to determine if a claim should be paid. |
| What are the responsibilities of Step 9 in the billing cycle? | List all services and their charges plus the amount paid by the insurance company and the remaining amount that is owed by the patient. |
| What are the responsibilities of Step 10 in the billing cycle? | Keep track of payments made to a patients account and proceed with steps if payment is not made. |
| What is a policy holder? | The person who buys insurance, the insured. |
| What is a premium? | The amount the policy holder pays for health insurance. |
| What is coinsurance? | The percentage of charges that an insured person pays for health care services after paying the deductible. |
| What is a deductible? | The amount due before benefits start. |
| What is a diagnosis? | A physicians opinion of the nature of the patients illness or injury. |
| What is coding? | The process of translating a description of a diagnosis or procedure into a standardized code. |
| What is medical necessity? | The connection between an illness or injury and the treatment or means of diagnosing that is used by the physician. |
| What is an explanation of benefits (EOB)? | A paper document sent from the insurance company to the patient that shows what they are covering and how it was determined. |
| What are the Administrative Safeguards of HIPAA? | Policies and procedures that protect electronic health information. EX. Policy manual and training. |
| What are the Physical Safeguards of HIPAA? | Mechanisms required to protect electronic systems, equipment, and data. EX. Back up of computerized information, restricting access to computers. |
| What are the Technical Safeguards of HIPAA? | Automated processes used to protect data and control access to data. EX. Passwords, antivirus and firwall software, and secure transmission systems. |
| When is a patient considered a new patient? | When they have not received services from that provider for a period of 3 years or more. |
| When is a patient considered an established patient? | When they have received services from that provider within 3 years. |
| What is a guarantor? | The person who is financially responsible for the patients account. |
| What is a primary insurance carrier? | The first insurance carrier that a claim is submitted to |
| What are access rights? | A security option that determines who can have access to certain patient information as well as who has the right to enter or edit that information. |
| What is protected health information? | Information about a patient's health or payment for healthcare that can be used to identify the person. |
| What is a breach? | The access, use, or disclosure of protected health information that violates HIPPA's Privacy Rule. |
| What is a clean claim? | Claims that are done correctly and do not require additional documentation. |
| What is HIPAA? | Increases accountability and decreases fraud and abuse in healthcare system. Mandates standards for health information and ensures the security and privacy of health information. |
| What is a clearinghouse? | A company that receives claims from a medical provider, checks them for errors, and sends them to the insurance company. |
Created by:
JennGuest
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