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