Week 1 REVIEW

call handling basics

100

it occurs when one advocate  answers a call and then transfers the call to a different advocate  but passes on any relevant information so that the caller doesn't have to repeat themselves.

Warm transfer 

200

This is the ability to understand and share the feelings of another. putting yourself in someone else's shoe. 

Emphaty 

300

What are the 3 elements of the Call 

Open Call and Identofy the Issue 

Research issue and keep caller Engaged

Resolve Issue and Close Call 

400

what do we call an improved approach in out interactions with Providers when responding to questions or helping resolve issues

Positive Engagement 

500

 HIPAA Compliance :

There are many entities that must comply with HIPAA, give one example 

• Providers: Doctors and Facilities 
• Health Care Clearing House: Public or private entity (Billing Service and Re-pricing Company)
• Health Plans: UnitedHealthcare

claim basics

100

what are the 2 types of claim  forms 

CMS 1500 

UB04

200

what are the Ways to submitt a  claim

electronic and paper (by mail ) submission 

300

What do we call claims that  are paid automatically ?

Auto- Adjudication 

400

what are the health care  providers that may use the UB-04

Hopitals

Skilled Nursing facilities

surgery cenetrsTreatment centers 

Urgent Care centers

Emergency facilities

500

CMS 1500 for is used by ? 

Physicians

Laboratories

Medical Supply stores

Meet our members

100

what are the Level of  plans  for Exchange 

Bronze

Silver

Gold 

200

What are the questions we ask to HIPPA verify.

name /DOB or ADDRESS 

300

What Type of plan is IFP 

HMO/ Exchange plan 

400

What are the Exchange Eligibility Requirements 

Live in the state in which applying for exchange plan 

A US citizen, national, or lawfully present immigrant 

Not incarcerated 

500

what are the other Names for Health Care Reform 

Health  Care reform law

Patient Protection affordability Care act (PPACA)

Affordability Care Act (ACA)

Obama Care 

Terminology

100

These codes represent the procedure done (office visit, surgery, diagnostic service, lab work, etc. 

Current Procedural Terminology (CPT)

200

These codes are used by physicians to identify why the patient went to the doctor

ICD-10 Codes/ Diagnosis Code/s

300

these codes are  for medical equipment, drugs, transportation services and other services not covered by CPT Codes. 

HCPCS Codes

400

What is the CPT Code Series for each range of codes?

70010-79999  

Radiology 

500

Which type of code is used exclusively by facilities?

REVENUE CODE 

Acronyms

100

OOP  

Out of Pocket 

200

UES

United Experience Survey

300

NPS 

Net Promoter System 

400

COB 

Coordination of Benefits

500

HIPAA

Health insurance Portability and Accountability Act