MJCC EHR Word Scramble
N P E C R T E
|
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
| Question | Answer |
| A set percent (%) of charges a patient may be required to pay according to the guidelines set forth by their insurance policy is called what? | Co-insurance |
| A lab report cannot be used for coding purposes because? | They have not been reviewed by a physician before inclusion into the record. |
| The letters "qhs" means: | At each bedtime |
| The use of the ePrescribing module is part of the requirement for? | Hipaa |
| What do the letters NOS indicate? | Not Otherwise Specified or Equals Unspecified |
| Where are patients listed and entered only once which allows for documentation of all office visits? | Master Patient Index (MPI) |
| Four types of information contained in a medical record? | Personal, Financial, Medical and Social information. |
| Lack of documentation during a patient visit could result in? | Decreased reimbursement |
| Most individuals receiving TANF payments are limited to a ______________ year benefit period. | 5 |
| The ICD-10-PCS includes procedure codes for the ___________? | patient |
| Insurance for low income people? | Medicaid |
| Currently, participation in the Physician Quality Reporting Initiative is ____________. | Voluntary |
| The common abbreviation for chest x-ray is? | CXR |
| Data may be structured or unstructured. Identify an example of unstructured data. | Dictated Report |
| A code that reports more than one diagnoses is a ____________________ code? | Combination |
| PMHX is an abbreviation for? | Patient's Past Medical History |
| When you report a procedure in addition to the primary procedure, this term is known as? | Add-on codes |
| What is meant by "code to the highest level of specificity"? | Using the most specific code possible |
| The method of determining insurance payments must be? | UCR-Usual, Customary and Reasonable |
| This type of technology translates what a provider is saying and types those words into text. | Voice Recognition |
| Claire works for a pediatrician's office that is considering the implementation of an EHR. She has been asked to research the different systems available and would like to create a list of functions the EHR should have specific to their practice she needs to get ____________________________? | doctor recommendations |
| The HCPCS codes are maintained by? | The Centers for Medicare and Medicaid Services |
| What identifying information that differentiates one patient from another, is collected as part of the administrative information? | Demographics |
| There must be an ____________ by the care provider, before any tests or treatment can be provided to a patient? | Order |
| Other systems designed to interact with Electronic Health Records, (EHR) and used for patient identification, orders, scheduling and testing/results? | Laboratory, Pharmacy and Radiology Systems |
| What type of statement needs to appear on a (fax cover sheet) when transmitting Personal Health Information? | Confidentiality statement |
| When working under a managed care plan, physicians agree to? | Accept fees that are predetermined by the plan. |
| To help guard against security breaches, emails containing protected health information should be? | Encrypted |
| If both parents cover dependents on their plan, the child's primary insurance is usually determined by the birthday rule. What is the birthday rule? | The parent whose birthday is earlier in the calendar year |
| Patient safety and reducing medical errors is extremely important in adopting an EHR system. What could be considered a contributing factor to medical errors? | Illegible or incorrectly interpreted handwritten orders |
| Only services deemed medically ________________ can be billed to insurance. | Necessary |
| When a policyholder contributes to his/her policy by paying a set amount of money on a Fee Schedule, is called their? | Premium |
| A set amount patients may be required to pay the provider for health care services before their benefits begin to pay is called a? | Deductible |
| What method is scheduling two patients to see the same physician at the same time? | Double booking |
| Reflects data from (all sources) that have treated an individual? | Electronic Health Record (EHR) |
| What is essential to proper E/M Code assignment? | Documentation |
| The process of entering fees for services on a patient account is referred to as? | Posting payments |
| An element of the user interface on which the user can click to execute a command such as confirm, cancel or exit? | Button |
| The ICD-9 have how many characters? | 3-5 characters |
| The method of (adding information) to the Electronic Health Record (EHR) is identified as? | SOAP note charting |
| A log that contains information about a prescription order and is used to document the administration of the medication to the patient is? | Medication administration Record |
| What form is used to submit hospital claims? | UB-04 form |
| A reference database (thesaurus) of medical terms? | UMLS |
| An active patient is defined as? | One who saw the provider within the last 3 years |
| A government program that provides insurance for persons over the age of 65? | Medicare |
| Multigravida is a term associated with? | Pregnancy |
| For whatever reason, what must be documented in the patient's medical record. | Making corrections in/on the appointment schedule |
| The ICD-10-CM is comprised of only what? | Diagnoses |
| The first three factors a coder must consider when coding are patient status, place and _______________ ? | Type of service |
| The process of moving a patient from appointment making through checkout is called? | Patient flow |
| What is the method of scheduling a patient for a specific appointment time? | Fixed appointment scheduling |
| The biggest advantage of voice recognition software over manual transcription is? | Speed of documentation |
| The three key factors in selecting an E/M code are? | History, Examination and Medical decision making |
| Physicians establish a list of their usual fees for? | The procedures and services they frequently perform. |
| The best definition for a company that processes health information and executes electronic transactions is: | Clearinghouse |
| Notes about a prescription ordered for a patient would appear in the __________ of a SOAP note? | PLAN |
| Insurance for (active duty) and (retired) service personnel and their families? | TRICARE |
| Health Maintenance Organization acronym? | HMO |
| A well integrated electronic healthcare system should be able to: transmit, store, receive and ___________ all medical services related to a patient's healthcare. | Protect |
| Indicates a patient's behavior or current status? | Status Code |
| Identifiers are a unique set of numbers (like SSN's) used in electronic transactions for Employers, Healthcare Providers, Health Plans and Patients and are called? | HIPAA National Identifiers |
| What section of a SOAP note would there be a brief summary of the patient's symptoms and may often include a diagnosis as well as a list of other possible diagnoses, usually in order of 'most likely, to least likely? | ASSESSMENT |
| Providers who had not adopted an EHR system by 2014 were subject to? | Financial penalties |
| For a specialist to document in a rapid and efficient way, many EHR companies provide what? | Pre-built office visits, physicians order and letter templates for each specialty. |
| Why should closed patient records be purged and placed in electronic storage? | Liability reasons in the event of medical malpractice. |
| Medicare pays | Covered services 80% |
| Standard templates, bar codes and numeric codes are what kind of data? | Structured data |
| Terms and codes used for electronic exchange of lab results and clinical observations? | LOINC |
| The ICD-10 have how many characters? | 3-7 characters |
| ______________________ is easily attained when using an EHR system. | Interoperability |
| Clinical vocabulary designed to encompass all terms used in medicine? | SNOMED-CT |
| Software that is used in a medical office is known as? | Practice management software |
| If a fracture is not documented as closed or open, it is always coded as? | Closed |
| What is the method of scheduling patients around the same block of time? | Cluster scheduling |
| The ability of separate EHR systems to share information in compatible formats is called? | Interoperability |
| How is payment received in and electronic office? | An electronic deposit is made into an online office account where money can then be transferred as needed. |
| What type of information is the patient's description of his/her own symptoms, including a chief complaint, or comments during an exam? | SUBJECTIVE information |
| Information such as policyholder name and insurance plan appear in what section of a claim form? | Subscriber |
| Information that is essential for an EHR Specialist to collect at the time of an appointment. | Correct spelling of patient's full name, address, telephone number, reason for visit, type of insurance, |
| What is the legal doctrine, that states that all medical services rendered must be reasonable and necessary to generally accepted clinical standards? | Medical Necessity |
| The anesthesia section in the E/M codes is used for the following types of anesthesia: local, regional and _____________ anesthesia? | general |
| An ONC meaningful use criteria mandates that a certified EHR program must be able to record the patient's? | Height, weight, blood pressure, BMI |
| On a prescription order, the "SIG" is what part of the prescription? | The instructions on taking the medicine. |
| Family members covered by parents insurance plan are called | Dependents |
| Which of the following is not a safety screening performed by the e-prescribing module within the EHR? | Drug-Tolerance |
| A dictated report, a written progress note, or voice files are what kind of data? | Unstructured data |
| Registration, Admissions, Discharge and Transfer acronym? | RADT |
| Providers/Physicians who agree to accept an insurance allowed amount as payment in full. | Participating/Preferred Providers |
| If a patient is admitted to the hospital 4 times in one year, how many times will they be entered in the Master Patient index? | Once |
| In documenting patient history, the letters PFSH stands for? | Past history, family history and social history |
| Not Elsewhere Classifiable acronym? | NEC |
| When is the secondary insurance plan billed? | After payment from the primary insurance is received |
| What is the proper action to take when a very ill patient enters the office? | Assist the patient into the examination room for them to wait comfortable until the physician is ready to see them. |
| What term is unique to ICD-10-CM and indicates that the condition being excluded is not part of the condition for the code listed but rather another code should also be assigned: | Excludes |
| What kind of information would it be where observations are made by a physician or EHR Specialist? | OBJECTIVE information |
| Codes that identify common types of patient visits, specify their typical duration and identify special instructions to handling each kind of visit? | Type of Visit Code |
| A set of common definitions for medical terms that ease communication by decreasing uncertainty? | Clinical vocabularies |
| Medical Identity theft is a type of fraud where a person's personal identity details are stolen. Examples of these details could include a social security number and a _________________ ? | Health Insurance ID |
| Codes that identify the procedures performed for a patient are called? | CPT Codes |
| What is a private, secure electronic file that is created, maintained and owned by the patient called? | Personal Health Record |
| The length of time records are stored by a medical office is called? | Retention Time |
| What is the abbreviation for a patient's expressed concern? | C/O |
| What allows doctors to document patient encounters in an EHR system on a structured form? | Clinical templates |
| A condition named for a person-such as Hodgkin's disease. | Eponym |
| An EHR Specialist will call the insurance company prior to? | Scheduling hospital services and admissions. |
| If a patient is injured in an automobile accident, what type of insurance is applicable? | Liability Insurance |
| When thinking of an Electronic Health Record, EHR, the word audit means? | A review of employee activity with in the EHR system |
| A generated term used to help the user (specific context) to carry out a particular task is called? | Context Specific |
| How many times is a patient entered into the (Patient List) or Master Patient Index? | Only once, which allows for documentation of each visit. |
| Used by physicians to access information about a disease or condition. | Decision Support Software |
| Computerized records of (one physician's) encounter with a patient over time and reflects treatment of that one physician? | Electronic Medical Records (EMR) |
| Procedures and any accompanying template text are automatically added into what area of the SOAP note when saved? | Assessment |
| _________________ are used to report encounters for circumstances other than a disease or injury in the ICD-10 CM? | Z codes |
| In using an EHR, the word "cloning" refers to? | Copying and pasting notes from a patient's previous visits into the current progress notes. |
| Often Doctor's do not have the expertise to treat a specific patient's condition. The doctor will send the patient to a board certified doctor for treatment which is called a? | Referral |
| Who manages a personal health record (PHR)? | The individual |
| Point of Service acronym? | POS |
| Exclusive Provider Organization acronym? | EPO |
| Notes about prescriptions ordered for a patient would appear in what section of the SOAP note? | Plan |
| Consultation letters are different from referral letters because, a consultation letter is? | When a doctor request the opinion or advice from another doctor. |
| A patient with Medicare is working at a small business with fewer than 15 employees. She also has a group plan with this employer. Which insurance is primary for medical services? | Employer Group plan |
| A beneficiary pays what? | deductible, premiums, co-insurance (20%) non-covered services |
| Administrative data is unnecessary for? | Providers |
| If a patient has had a malignancy removed and no further treatment is needed it is coded as: | History |
| The format for the ICD-10-PCS is? | A 7 digit code with a combination of numbers and letters |
| According to the flow of information what comes next: appointment scheduling, front desk/check in, nursing clinical support, __________________. | Care Provider |
| Preferred Provider Organization acronym? | PPO |
| The acronym HIE stands for: | Health Information Exchange |
| What method is it when patients are scheduled for the first half of each hour, and each patient is seen in the order they arrive? | Wave scheduling |
| The actual charge less/minus the allowed amount. | Approved/Allowed Amount |
| Who should be billed for the treatment of an emancipated minor? | The Minor |
| Insurance for (Veteran's) with service related disabilities? | CHAMPVA |
| What type of insurance covers employees that are injured on the job? | Worker's compensation |
| The EHR specialist must ensure that each part of the___________ is accurate, and up to date. | medical records |
| A CPT code that indicates the code description has been revised? | Blue Triangle |
| Codes that identify common types of patient visits, specify their typical duration and identify special instructions to handling each kind of visit, are called? | Type of Visit Code (TOV) |
| Physicians, hospitals and other suppliers that furnish care or supplies to patients are called? | Providers |
| What refers to treatment without admission to a hospital? | Ambulatory Care |
| A UB-04 is used to submit? | Hospital claims |
| EHRC Specialist job duties | Submitting insurance claim forms, patient check in and check out, insurance verification, scheduling appointments. |
| Rules that require the usage of password protection on all electronic devices used to access patient information? | HIPAA Security Rules |
| When you electronically archive patient records, where do they go? | To archive media such as a CD or a hard drive |
| The primary care physician for some types of managed care plans is also referred to as the? | The Gatekeeper |
| What is it called when offices charge fees based on a patient's financial ability? | Sliding Fee Scale |
| Conditions that remain after a patient's acute illness or injury has ended - could be called residual effects or late effects. | Sequelae |
| Which acronym was one of the first terms used in the idea of storing medical information electronically? | EHR |
| A list of all medical procedures and their respective allowed amounts charged by any insurance company is known as? | Fee Schedule |
| The format for Level II codes in the HCPCS is a letter followed by how many numbers? | Four |
| What is the most common encounter with patients in an ambulatory setting? | Office visit |
| A unique patient identifier acronym, that links all clinical observations, tests, procedures, complaints, evaluations, and diagnoses to the patient? | UPI |
| Using a __________________ will ensure each member of the staff has defined the data element correctly. | Data Dictionary |
| Health Level 7 (HL7) standards allow what: | Allows different software to interface with each other |
| Employers that pay directly for 'employees' medical bills | Health Insurance Terminology, Self ensured |
| Most often refers to (care in a hospital) where patients are treated with urgent problems, that cannot be handled otherwise is called? | Acute care |
| What part of the SOAP note is it added to when a care provider gathers information from performing a physical exam? | Assessment |
| Evaluation and Management Codes (E/M Codes) are based on three factors: history, physical examination and: | Evidence of medical decision making |
| What is the purpose of a billing audit? | To identify poor coding |
| The amount an insurance company may say is not allowed and not the responsibility of the patient would be identified as an ___________________ on the patient's account? | Adjustment |
| Which of the following contains codes for certain products, supplies and services that do not appear in the CPT manual? | HCPCS |
| An EHR function that allows a doctor or another prescriber to order medication and tests using an automated format is called a? | Computerized Physician Order Entry (CPOE) |
Created by:
Healthtrade
Popular Medical sets