Chapter 6
This is an example of a third party
Medicare
Double Jeopardy!!!!
___________ is a uniform language for describing procedures and treatments performed by healthcare providers
CPT
Double Jeopardy!!!!!!
An outcome-based payment model that rewards providers for delivering evidence-based care according to specific standards and for electronically documenting compliance with those standards is known as
P4P
This is a comprehensive, electronic or paper-based
record of health information controlled by the
individual, through which he or she can
access, manage, and share confidential
health information
PHP
the person responsible for the account
Guarantor
The process of assigning standard numeric or alphanumeric characters to diagnoses, procedures, and treatments is called
Coding
Services related to office visits and hospital observation codes are coded from
evaluation and management
_______________ is a legal doctrine that holds that medical services rendered must be reasonable and necessary according to generally accepted clinical standards
Medical Necessity
These are types of Personal Health Records
Paper-based personal health record
Personal health record software
Online personal health record
A device that encodes documents in order to transmit them over telephone lines is a/an
Fax Machine
Another name for coding variances is
Mistake
Ultrasound would be coded from
Radiology
Double Jeopardy!!!!
____________ is knowingly misrepresenting the medical services provided to deceive or mislead another person or entity
Fraud
This is sometimes referred to as a “tethered PHR”Provider-controlled gateways to an EHR and
other services at the healthcare facility
Patient Portal
The office manager reviews the staff ____________ every 6 months to determine if any unauthorized information was accessed
Audit Trail
This contain a tabular list of diseases
ICD-10
A tetanus injection would be coded from
Medicine
____________ is unintentional deception in which a provider inappropriately bills for services that are not medically necessary, do not meet current standards of care, or are not medically sound.
Abuse
the ability of computer systems or software to exchange and make use of information.
Interoperability
Double Jeopardy!!!!
Encryption and decryption technology are examples of
technical safeguards
When creating a claim in SimChart for the Medical Office, which tab is used to enter the services provided to the patient?
Charge Capture
__________ codes are supplemental codes used to help researchers collect data, track illness and disease, and measure quality of care
Category II
All charges, payments, and adjustments are recorded on the
Ledger
Another name for a superbill
Encounter form
This prohibits physicians from referring Medicare beneficiaries to an entity in which they (or an immediate family member) have a financial relationship (including compensation and ownership relationships) for “designated health services” (DHS) unless an exception applies.
Stark law