Insurance Chap 1 And 2

Front 1

a physician may have problems that can affect obtaining maximum payment for services. He or she relies on professionals to handle ________, ___________ _____________, and _______-____ of claims.

Back 1

billing

electronic transmission

follow-up

Front 2

2 billing components exist: _________ billing and _________________ billing

Back 2

Facility

Professional

Front 3

__________ billing is charging for services performed by physicians or non-physician practitioners.

Back 3

Professional

Front 4

_______________ billing is charging for services done in hospitals, acute care hospitals, skilled nursing or long-term care facilities, rehabilitation centers, or ambulatory care surgical centers.

Back 4

Facility

Front 5

An _____ is an individual who has not obtained a medical degree but is allowed to see patients and prescribe medications. These people are sometimes referred to as _________ _____________.

Back 5

NPP

physician extenders

Front 6

An _____________ ___________ _____________ must realize that NPPs should have a provider number and are permitted to submit claims to third party payers.

Back 6

insurance billing specialist

Front 7

There may be occasions when the patient does not see a physician but is directed to the ____

Back 7

NPP

Front 8

Proper authorization and documentation is required and then a financial record source document called an ________ form is generated for the NPP.

Back 8

encounter

Front 9

Payment schedules for payment of professional services are based on the ________ type

Back 9

payer

Front 10

Under Medicare, physicians are paid according to relative value units, which are based on 3 things: the _______ of ___________ _________

_________ _____________ and

the _____________ ______________

Back 10

the cost of delivering care

Malpractice insurance

the physicians work

Front 11

A fee schedule is published by the ___________ ____________ ______________ (CMS)

Back 11

Centers for Medicare and Medicaid Services

Front 12

___________ _________ organizations establish their own physican fee schedules

Back 12

Managed care

Front 13

Whether you are employed to perform hospital or professional billing functions, the basic setup of a business encompasses the following units or combined departments: ___________________________

___________________________

___________________________

___________________________

Back 13

reception of the patient

rendering of medical services

documentation of the services

financial accounting

Front 14

Office procedures performed throughout a workday include the following:

Back 14

Scheduling appointments

Registering patients

Documenting pertinent clinical notes

Posting a charge entry

Bookkeeping and accounting

Front 15

Individuals called _______ ___________ ________ (CAPs) work for the consumer

Back 15

claims assistance professionals

Front 16

_____ _______ is the amount of actual money generated and available for use by he medical practice within a given period of time.

Back 16

cash flow

Front 17

in 1997 the __________ ____________ of _____________ ____________ (AAMA) developed a role delineation study analyzing the many job functions of the medical assistant

Back 17

American Association of Medical Assistants

Front 18

The ________ ___________ ___________ _____________ ___________ (AHIMA) has published diagnostic and procedure coding competencies for outpatient services and diagnostic coding and reporting requirements for physician billing.

Back 18

American Health Information Management Association

Front 19

Before beginning work as an insurance billing specialist, it is wise to have a basic knowledge of medical ________ as it pertains to the medical profession.

Back 19

ethics

Front 20

_____________ in the health care industry is the process of meeting regulations, and expectations of federal and state agencies.

Back 20

Compliance

Front 21

The term _________ ________ applies to any heakth care provider who transmits any health information in electronic form.

Back 21

covered entity

Front 22

HIPAA requires the designation of a _________ _________ (PO) to develop and implement the organization's policies and procedures.

Back 22

privacy officer

Front 23

A __________ __________ is a person or entity that performs certain functions or activities using health care information on behalf of a covered entity

Back 23

business associate

Front 24

A _________ __________ protects the computer and networking systems within the practice and implements protocols such as password assignment, backup procedures, firewalls, virus protection and contingency planning for emergencies.

Back 24

privacy officer

Front 25

__________________ is the condition of being secluded from the presence or view of others.

Back 25

Privacy

Front 26

_____________ is using discretion in keeping secret information.

Back 26

Confidentiality

Front 27

_____________ ____________ is a privileged communication that may be disclosed only with the patient's permission.

Back 27

Confidential communication

Front 28

________________________ information consists of ordinary facts unrelated to treatment of the patient, including the patient's name, city of residence, and dates of admission or discharge.

Back 28

Nonprivileged

Front 29

_____________ means "alleviate the severity."

Back 29

Mitigation

Front 30

___________ can occur when deception is used in a claim submission to obtain payment from the payer.

Back 30

Fraud

Front 31

__________ means incidents or practices by physicians not usually considered fraudulent, that are inconsistent with accepted sound medical business or fiscal practices

Back 31

abuse

Front 32

____ __ in the FCA provisions allows a private citizen to bring a civil action law suit for violation on behalf of the federal government.

Back 32

Qui tam

Front 33

A _______________ plan requires that a health care practice review all billing processes through audits and establish controls that will correct weaknesses and prevent errors.

Back 33

compliance