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32 Cards in this Set

  • Front
  • Back
ACCOUNTING CYCLE
THE FLOW OF FINANCIAL TRANSACTIONS IN A BUSINESS
ACCOUNTS RECEIVABLE (AR)
A TERM USED TO DESCRIBE MONEY COMING IN TO A BUSINESS
ACKNOWLEDGEMENT OF RECEIPT OF NOTICE OF PRIVACY PRACTICES
UNDER THE HIPAA PRIVACY RULE, A FORM THAT NEW PATIENTS MUST READ AND SIGN TO BE INFORMED OF THE MEDICAL OFFICE'S PRIVACY PRACTICES
CAPITATION
A FIXED AMOUNT THAT IS PAID TO THE PROVIDER IN ADVANCE TO PROVIDE MEDICALLY NECESSARY SERVICES TO PATIENTS
CO-INSURANCE
UNDER AN INSURANCE PLAN, THE PORTION OR % OF THE CHARGES THAT THE PATIENT IS RESPONSIBLE FOR PAYING.
CO-PAYMENT
A SMALL FIXED FEE THAT IS PAID BY THE PATIENT AT THE TIME OF AN OFFICE VISIT
DIAGNOSIS CODE
A VALUE THAT STANDS FOR A PATIENT'S ILLNESS, SIGNS, OR SYMPTOMS.
ENCOUNTER FORM
A FORM LISTING PROCEDURES RELEVANT TO THE SPEICALTY OF A MEDICAL OFFICE, USED TO RECORD THE PROCEDURES
EXPLANATION OF BENEFITS (EOB)
A PAPER DOCUMENT FROM A HEALTH PLAN THAT LISTS THE AMOUNT OF A BENEFIT AND EXPLAINS HOW IT WAS DETERMINED.
FEE-FOR-SERVICE
AN INSURANCE PLAN WHERE POLICY HOLDERS ARE REIMBURSED FOR HEALTH CARE COSTS.
HEALTH MAINTENANCE ORGANIZATION (HMO)
A TYPE OF MANAGED CARE SYSTEM IN WHICH THE PLAN PAYS FIXED RATES AT REGULAR INTERVALS.
HEALTH PLAN
A PLAN, PROGRAM, OR ORGANIZATION THAT PROVIDES HEALTH BENEFITS.
HIPAA (HEALTH INSURANCE PROTABILITY AND ACCOUNTABILITY ACTO OF 1996)
FEDERAL GOVT ACT THAT SET GUIDELINES FOR STANDARDIZING THE ELECTRONIC DATA INTERCHANGE OF ADMINISTRATIVE AND FINACIAL TRANSACTIONS.
HIPAA PRIVACY RULE
REGULATIONS FOR PROTECTING INDIVIDUALLY IDENTIFIABLE INFORMATION ABOUT PATIENTS
MANAGED CARE
A TYPE OF INSURANCE IN WHICH THE CARRIER IS RESPONSIBLE FOR THE FINANCING AND DELIVERY OF HEALTH CARE.
PATIENT INFORMATION FORM
A DOCUMENT THAT CONTAINS PERSONAL, EMPLOYEMENT AND MEDICAL INSURANCE INFORMATION ABOUT A PATIENT.
PAYER
PRIVATE OR GOVT ORGANIZATION THAT INSURES OR PAYS FOR HEALTH CARE.
POLICYHOLDER
AN INDIVIDUAL WHO HAS CONTRACTED WITH A HEALTH PLAN FOR COVERAGE.
PREFERRED PROVIDER ORGANIZATION (PPO)
A NETWORK OF HEALTH CARE PROVIDERS WHO AGREE TO PROVIDE SERVICES TO PLAN MEMBERS AT A DISCOUNTED RATE
PREMIUM
PAYMENTS MADE TO A HEALTH PLAN BY A POLICYHOLDER FOR COVERAGE
PROCEDURE CODE
A NUMBER THAT REPRESENTS MEDICAL PROCEDURES THAT WERE PERFORMED
REMITTANCE ADVICE (RA)
AN ELECTRONIC DOCUMENT FROM A HEALTH PLAN THAT LISTS THE AMOUNT OF A BENEFIT AND EXPLAINS HOW IT WAS DETERMINED
TRUE
TRUE/false
MANY PATIENT INFO FORMS CONTAIN A PLACE FOR THE PATIENT TO SIGN TO AUTHORIZE THE PATIENT'S HEALTH PLAN TO SEND PAYMENTS DIRECTLY TO A PROVIDER
FALSE
T/F
CPT-4 CODES HAVE EIGHT DIGITS
FALSE
T/F
CO-INSURANCE REFERS TO A SMALL FIXED FEE THAT MUST BE PAID BY THE PATIENT AT THE TIME OF AN OFFICE VISIT
TRUE
T/F
THE HIPAA PRIVACY RULE PROTECTS PATIENT'S PRIVATE INFO
SIX BASIC CATEGORIES OF BILLING TASKS IN OFFICE
1. SCHEDULING PATIENT APTS
2. GATHERING & RECORDING PYMT INFO
3. RECORDING PROCEDURES & SERVICES PERFORMED
4. FILING INSURANCE CLAIMS AND BILLING PATIENTS
5. REVIEWING AND RECORDING PAYMENTS
6. BALANCING THE ACCOUNT
A PATIENT INFORMATION FORM CONTAINS INFO SUCH AS NAME, ADDRESS, EMPLOYER, AND _____________.
INSURANCE COVERAGE
A HEALTH MAINTENANCE ORGANIZATION (HMO) IS ONE EXAMPLE OF ____________.
A MANAGED CARE HEALTH PLAN.
IN A MANAGED CARE HEALTH PLAN, A _____________ IS USUALLY COLLECTED FROM THE PATIENT AT THE OFFICE VISIT.
CO-PAYMENT
THE MOST COMMONLY USED SYSTEM OF MEDICAL PROCEDURE CODES IS FOUND IN THE _____.
CPT
INFORMATION ABOUT A PATIENT'S MEDICAL PROCEDURES THAT IS NEEDED TO CREATE AN INSURANCE CLAIM IS FOUND ON THE ____________ __________.
ENCOUNTER FORM