Full Form
RCM?
REVENUE CYCLE MANAGEMENT
3Ps of US HEALTHCARE?
PATIENT
PROVIDER
PAYOR
DEFINITION OF SUBSCRIBER?
INDIVIDUAL WHO BUYS THE POLICY AND PAYS THE PREMIUM.
WHICH STAGE OF RCM COMES AFTER APPOINTMENT SCHEDULING?
ELIGIBILITY CHECK AND BENEFIT VERIFICATION.
AOB?
FULL FORM AND EXPLANATION.
ASSIGNMENT OF BENEFITS
A DOCUMENT SIGNED BY THE PATIENT TO AUTHORIZE THE PROVIDER TO RECEIVE CLAIM PAYMENT DIRECTLY FROM THE PAYOR.
SNF
SKILLED NURSING FACILITY
EXPLAIN NEW PATIENT.
PATIENT WHO IS VISITING THE PROVIDER FOR THE FIRST TIME OR AFTER 36 MONTHS.
DEFINITION OF DEPENDENT?
FAMILY MEMBERS OF THE SUBSCRIBER WHO ARE ELIGIBLE TO GET THE BENEFITS UNDER THE POLICY BUT NOT PAYING PREMIUM,
EG: CHILDREN, MOM, DAD.
MEDICAL CODING INCLUDES
1)
2)
3)
1)DIAGNOSIS CODE
2)PROCEDURE CODE/REVENUE CODE
3)MODIFIER
WHAT IS SUPERBILL?
A DOCUMENT WHICH IS PREPARED DURING THE ENCOUNTER OF THE PATIENT WITH THE PROVIDER,IT HELPS THE CHARGE ENTRY TEAM TO ASSIGN THE CHARGE FOR SERVICES GIVEN TO THE PATIENT,
EG: ENCOUNTER FEE, TICKET SERVICE SLIPS OR ROUTING FORM.
ICD
INTERNATIONALE CLASSIFICATION OF CURRENT DISEASES
EXPLAIN ESTABLISHED PATIENT AND OUT PATIENT.
ESTABLISHED PATIENT- PATIENT WHO IS VISITING THE PROVIDER WITHIN 36 MONTHS.
OUT PATIENT- PATIENT WHO IS TAKING SERVICES FOR LESS THAN 24HRS.
DIFFERENCE BETWEEN ENROLLMENT DATE AND EFFECTIVE DATE?
ENROLLMENT DATE- THE DATE WHEN THE SUBSCRIBER ENROLLS WITH THE INSURANCE.
EFFECTIVE DATE- DATE WHEN THE INSURANCE STARTS TO COVER THE HEALTHCARE EXPENSES.
EXPLAIN ENCOUNTER AND DATE OF SERVICE.
ENCOUNTER- THE MEETING BETWEEN PATIENT AND PROVIDER IS CALLED "ENCOUNTER".
DOS- THE DATE WHEN THE PROVIDER RENDERS THE SERVICES.
FULL FORM OF ICD AND CPT?
EXPLAIN THE FORMAT
ICD- INTERNATIONALE CLASSIFICATION OF CURRENT DISEASES
FORMAT 1ST DIGIT ALPHA, 6 DIGIT CODE, DECIMAL AFTER 3 DIGIT.
CPT- CURRENT PROCEDURAL TERMINOLOGY
FORMAT- 5 DIGIT NUMERIC OR ALPHA NUMERIC,
6 CPT CODES CAN BE ENTERD IN CMS 1500 FORM PRINTED IN THE BOX 24#
CPT
CURRENT PROCEDURAL TERMINOLOGY
AN INDIVIDUAL WHO IS THE FIRST POINT OF CONTACT TO PATIENT ALSO CALLED AS REFERRING PROVIDER OR GATEKEEPER.
1)PCP
2)ORDERING PROVIDER
3)SPECIALIST
PCP- PRIMARY CAR PHYSICIAN
DIFFERENCE BETWEEN COOLING PERIOD AND COVERAGE PERIOD?
COOLING PERIOD- PERIOD BETWEEN ENROLLMENT DATE AND EFFECTIVE DATE.
COVERAGE PERIOD- PERIOD BETWEEN THE EFFECTIVE DATE AND TERMINATION DATE.
EXPLAIN THE WORKFLOW OF RCM STAGES
MEDICAL TRANSCRIPTION AND MEDICAL CODING.
MEDICAL TRANSCRIPTION- PROVIDER UPLOADS THE AUDIO FILES THAT HE HAD RECORDED IN ENCOUNTER STAGE, MEDICAL TRANSCRIPTIONIST DOWNLOAD THEM AND COVERTS THESE VOICE FILES INTO TEXT DOCUMENTS. LATER ON THESE FILES ASSIGNED TO MEDICAL CODERS.
MEDICAL CODING- CODERS CODE THE TEXT FILES INTO RESPECTIVE CODES.
EXPLAIN IN DETAIL
CHAMPUS
CHAMPVA
CHAMPUS - ALSO KNOWS AS TRICARE, THIS IS A PROGRAM FOR THE INDIVIDUALS WHO ARE STILL SERVING THE ARMED FORCES AND THEIR FAMILY MEMBERS IF THEY ARE REGISTERED WITH "DEERS'
CHAMPVA - IS A PROGRAM FOR THE INDIVIDUALS WHO HAVE BECOME PERMANENTLY DISABLED ON THE LINE OF DUTY AND FOR THE FAMILY MEMBERS OF THOSE WHO HAVE EXPIRED IN THE LINE OF DUTY.
HIPPA
HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT 1996
TYPES OF PROVIDER?
1)PCP
2)SPECIALIST
3)ORDERING PROVIDER
4)SKILLED NURSING FACILITY
5)HOME HEALTH
6)HOSPICE
EXPLAIN PRE EXISTING CONDITION AND WAITING PERIOD?
PRE EXISTING CONDITION- THE ILLNESS WHICH IS PATIENT IS SUFFERING FROM BEFORE PURCHASING THE POLICY.
WAITING PERIOD- THE TIME GAP BETWEEN THE EFFECTIVE DATE AND THE DATE BEGINNING WHICH INSURANCE WILL BE RESPONSIBLE FOR A PAYMENT ON PRE EXISTING DISEASES KNOW AS WAITING PERIOD.
STAGES OF RCM CYCLE.
1)APPOINTMENT SCHEDULING
2)ELIGIBILITY CHECK AND BENEFIT VERIFICATION
3)REGISTRATION PRE ENCOUNTER
4)ENCOUNTER
5)MEDICAL TRANSCRIPTION
6)MEDICAL CODING
7)CHARGE ENTRY/ CHARGE CAPTURE
8)CLAIMS GENERATION AND SUBMISSION
9)INSURANCE
10)PAYMENT POSTING
11)ACCOUNTS RECEIVABLES
12)DENIAL MANAGEMENT
WAIVER OF LIABILITY?
A DOCUMENT SIGNED BY TH PATIENT TAKING RESPONSIBILITY OF PAYMENT FOR SERVICES GIVEN BY THE PROVIDER, ONLY WHEN INSURANCE REFUSES TO COVER THE BENEFITS.