Patient Appointments
Name a type of written policy needed to ensure consistency when scheduling patients.
Routine appointments, acute illness, no-show, and rescheduling appointment policies.
This type of filing, used with administrative forms (such as HIPAA privacy notices, photo ID and insurance cards), is arranged so that the most recent item is on top and older items are filed further back.
Reverse chronological order
What is the first thing the MA should do when a patient enters the office if they are working the reception desk?
Greet the patient politely
This is the specific amount of money that a patient must pay out of pocket before the insurance begins paying for services every year.
Deductible
These codes translate diseases and injuries into alphanumeric codes that are used for submission for services for reimbursement and for statistical data.
BONUS: What are the procedural codes called?
ICD-10-CM codes - BONUS: CPT codes
Name a disadvantage of paper charts.
Used by one person at a time
Misplaced due to filing errors
Cannot be easily shared with other providers
A MA has a paper chart on her desk, waiting on a call back from another provider. What should the MA do at the end of the day?
Lock the chart up prior to leaving the office.
When checking in a patient, payment for the visit should be collected. How does the MA know how much to collect?
Review insurance information. Some pts are responsible for full amount until they meet their deductible, then the coinsurance amt applies. Others have a set copay due at time of service.
A MA calls an insurance company for eligibility and benefit information, what questions should the MA ask?
Effective dates
Deductible amount
Copays/Coinsurance
Exclusions or limitations
If prior authorization or referrals are required
Where claims should be sent
Who they spoke to to obtain the information
When reviewing a claim for insurance insurance, what should the MA verify?
Correct procedural coding and diagnoses are used for each procedure
Medical documentation (procedure and progress notes) substantiates the charges
Scheduling software, such as NextGen PM, create a matrix for scheduling appointments. What are some of the things the matrix takes into account?
Provider, available times, types of appointments, available resources (lab, procedure room).
A MA is purging old charts from the file room. What is the minimum time that a Medicare patient's chart must be retained?
10 years
What documents might a patient sign when checking in?
Consent to treat, HIPAA privacy notice, informed consent
If an individual is unable to pay for services, what should the MA be aware of?
Sliding scale pricing
Payment schedules (payment plans) - patient may need to sign a Federal Truth in Lending Statement (payments <4 months)
Indigent programs through social services or community hospitals
Local agencies that can aid patients in times of need
A MA knows her office uses a clearinghouse prior to submitting claims. What do they do?
Scrub claims (correct errors or complete missing information) and remit for payment
If a patient calls with a potential life-threatening emergency, what should the MA do?
Obtain callers name, phone number, and address, assist to call EMS/911, stay on phone until EMS arrives.
This is a function in the electronic health record that allows providers to digitally order laboratory and radiology testing, treatments, referrals, and prescriptions. BONUS: What federal policy requires providers to use this?
CPOE (Computerized Provider Order Entry)
HITECH Act and Meaningful Use Program (2009)
When preparing to open the office for the day, what is important for the MA to remember?
All necessary equipment is turned on (computers, lab equipment, lights)
Print schedules
Answering messages from the night before
Exam rooms are stocked
A MA asks a patient to sign an ABN, what does this form mean?
A advance beneficiary notice is for a Medicare patient to sign when the provider thinks Medicare may not pay for a specific service or item. It gives the patient the choice to submit the claim to Medicare to let them make the payment decision, pay for it out of pocket, or deny the service.
When obtaining a prior authorization, what should the MA document?
Authorization code
Date the auth code is effective and when it expires
Authorized diagnosis and procedural codes
Contact info for the specialist office
How many visits are authorized
What the auth has been issued for
What information is needed when scheduling an established patient visit?
Name, DOB
Reason for visit
Amount of time provider will need
Day of week or time patient prefers
A patient's attorney calls the office and requests to review medical records for a patient. What should the MA require of the attorney?
Either a release of information signed by the patient or a legal power of attorney document that authorizes them to view the medical records on behalf of the patient.
What types of identification does the patient need to provide prior to their appointment?
Photo ID and insurance card
A patient brings in an EOB with some questions. What is the patient asking about?
Explanation of Benefits is a document from the insurance company that details what services were paid, denied, or reduced in payment. It also includes what was applied to deductible, coinsurance, or allowed amounts.
In what cases should the MA adjust charges off of a patient account?
Insurance disallowances
Professional discounts
Account write-offs
Payments sent to practice after the account has been sent to collections
Patient files bankruptcy