Amca Maa Billing & Coding

Co-Payment - answer-Some contract insurance plans require a "fixed amount" be paid for the office visits. This amount is usually collected at the time of the visit. Term Deductible - answer-Amount of money that the insured must incur before the policy begins to pay. Network - answer-When multiple computers are linked together and share information Informed Consent - answer-Giving the patient adequate information concerning the method, risk and consequences prior to a procedure Assignment of Benefits - answer-A statement authoring the insurance company to pay benefits to the physician Chief Complaint - answer-The symptoms a patient is currently seen for STAT - answer-If the doctor wants test done immediately, the test is said to be ordered on a "___" basis Patient's Bill of Rights - answer-Health policies concerning the patient's constitutional right to privacy, confidentiality, and informed consent Physician ends relationship with a patient - answer-Thorough documentation, in writing to the patient, the reason for withdrawing from the case and offer specified number of days to seek a new physician Appendix E - answer-List of Three Digit Categories in the ICD-9 NEC - answer-Indicates the use of a code assignment for "other" when a more specific code does not exist Malignant - answer-Used to describe a cancerous tumor that grows worse over time. In Situ - answer-Malignancy that is located within the original site of development CHAMPVA - answer-Veterans with service related to disabilities are eligible for care under this program Dependents - answer-Family members, such as spouse or children, who are covered under the member's insurance policy Electronic Medical Records or E M R - answer-Computerized records of one physician's encounter with a patient over time. Electronic Health Record or E H R - answer-Reflects the data from all sources that have treated the individual. Personal Health Record or P H R - answer-Maintained and owned by the patient. Patient makes the decision to share contents with the Physician Acute Care - answer-Most often refers to hospitals, treats patients with urgent problems that cannot be handled. Ambulatory Care - answer-Refers to treatment without admission to hospital. Clinical Templates - answer-Allows doctors to document patient encounters into an E H R on a structured form. R A D T - answer-Refers to Registration, Admissions, Discharge and Transfer Unique Patient Identifier or U P I - answer-links all clinical observations, tests, procedures, complaints, evaluations, and diagnoses to the patient. Clinical Vocabularies - answer-Set of common definitions for medical terms that ease communication by decreasing uncertainty. SNO MED C T - answer-Clinical vocabulary designed to encompass all terms used in medicine LO INC - answer-Terms and codes used for electronic exchange of lab results and clinical observations. U M L S - answer-Thesaurus database of medical terms Fixed Appointment Scheduling - answer-One patient is scheduled for a specific appointment time. Cluster Scheduling - answer-To schedule a group of patients around the same block time who are coming in to receive the same type of service Double Booking - answer-When two patients are scheduled to see the same physician at once. Wave Scheduling Method - answer-To accommodate a large amount of patients. Patients are scheduled the first half of each hour and are seen in the order in which they arrive. Alphabetical Filing System - answer-Filed according to patient's last name Cross Referencing - answer-Blank file for each last name for patient's with a hyphened last name directing them to the patient's actual file. Numeric Filing System - answer-Information regarding each patient is stored using a number instead of the patient's last name. A method which helps to mask the patient's identity. Personal and Financial Information - answer-Insurance data, marital status, next of kin, and other items collected for personal identification. Medical Information - answer-includes the main reason patient seeks care,family/ patient medical history, exam results, physical exam forms, lab reports, and any other report that pertains to the patient's health care. Social Information - answer-includes items such as race, ethnicity, hobbies and lifestyles choices. Self Insure - answer-employers pay directly for employee's medical bills Sliding Fee Scale - answer-When offices charge fees based on a patient's financial ability to pay. Beneficiary - answer-Individuals who qualify for the program Premium - answer-The policyholder contributes to his/her policy by paying a set amount of money Approved / Allowed Amount - answer-The actual charge less then the allowed amount Usual, Customary, and Reasonable or U C R - answer-. Method of determining insurance payments. Participating/ Preferred Provider - answer-providers/ physicians agree to accept the insurance allowed amount as payment in full. Managed Care Plans - answer-Controls the costs associated with the insurance plan by controlling the amounts the reimburse health care providers. The 4 types are H M O, P P O, E P O, P O S E P O - answer-Exclusive Provider Organiztion Electronic Data Interchange or E D I - answer-sends claims electronically to a payer. Transactions - answer-activities involving the transfer of health care information Transmission - answer-the movement of electronic data between two entities and the technology that support the transfer. Code Sets - answer-codes that identify specific diagnosis and clinical procedures on claims and encounter forms Federal Register - answer-the official publication for all Presidential Documents, Rules and Regulations, Proposed Rules, and Notices Centers for Medicare and Medicaid Services or C M S - answer-. Handles the daily operation of the medicare program through the use of Medicare Administration Contractors. MAC's Beneficiary Pays - answer-deductible, premiums, co-insurance 20% non covered services Medicare Pays - answer-covered services 80% Managed Health Care - answer-Establishing networks of health care providers that offer a variety of health care services under an umbrella of a single organization. Managed Care Organization or M C O - answer-Group that is responsible for the health care services offered to a group or person Chapter - answer-main devision Section - answer-group of 3 digit categories that represent a group of conditions or related conditions Category - answer-3 digit code that represents a single condition or disease Sub Category - answer-4 digit code that provides more information or specificity as compared to the 3 digit code i terms of the cause, site or manifestation of the condition Brackets { } - answer-encloses synonyms, alternative wording or explanatory phrases. Identifies manifestation codes Parentheses ( ) - answer-used in both the index and tabular list to enclose supplementary words. non essential modifiers Colon : - answer-used in the Tabular List after an incomplete term which needs one or more of the modifiers Eponyms - answer-diseases or syndromes named after people Numbers - answer-Always comes first whether Arabic, Roman, or Ordinal Evaluation & Management or E & M - answer-3 factors are Place of service, Type of service, and Patient status. Levels are based on History, Exam, & Medical Decision Making Complexity. Type of Service - answer-Consultation, Admission, Newborn Care, Office Visit Patient Status - answer-New, Established, Outpatient, Inpatient Contributory Factors - answer-Counseling, Coordination of care, nature of presenting problem and Time History - answer-Four elements Chief Compliant - answer-History of present illness. Review of symptom. Past, Family and or Social History. History Levels and Examination Levels - answer-Problem Focused. Expanded Problem Focus. Detailed. Comprehensive Medical Decision Making Complexity Levels - answer-4 levels of Straightforward, Low, Moderate. Straightforward - answer-Minimal diagnosis. Minimal risk. Minimal complexity of data Low - answer-Limited diagnosis. Limited risk to patient. Limited data Moderate - answer-Multiple diagnoses. risk to patient. amount and complexity of data High - answer-Extensive diagnoses. risk to patient. amount and complexity of data Outpatient Visits - answer-measured as direct, face to face. this time is spent with the physician Inpatient Visits - answer-measured as unit and floor time. this time is spent in an hospital setting Designated Record Set or D R S - answer-any item, collection, or grouping of information that includes protected health information and is maintained by a covered entity Electronic Protected Health Information or ePHI - answer-protected health information that is created, received, maintained or transmitted in electronic media or in any other form or medium. Notice of Privacy Practices or N P P - answer-document that describes practices regarding the use and disclosure of protected health information Protected Health Information or P H I - answer-individually identifiable health information that is transmitted or maintained by electronic media or in any other form or medium Treatment, Payment, and Operations or T P O - answer-conditions under which protected health information can be released without consent from the patients Unstructured Data - answer-A dictated report, a written progress note, or voice files Structured Data - answer-standard templates, bar codes, and numeric codes Decision Support Software - answer-used to access current information about a disease or condition. Used by physicians Voice Recognition Software - answer-translates what a provider is saying and types those words into text Master Pati