Vocabulary
An order from a provider for a patient to see a specialist or to obtain specific medical services
Referrals
Has not received services from the provider or same group (an same specialty) within 3 year - includes known complaint/ condition. Approx. time required 60 minutes
New patient
Patients are scheduled in groups with common medical needs
Clustering
What are CPT Codes and name a type of code
Medical services or procedures performed by the provider
What is included on the encounter form?
Reason for the visit and what was done during the visit.
Current Procedural Terminology codes that identify medical services and procedures performed by a provider
CPT Codes
Comprehensive
In what scenario would a patient be prioritized over another?
An electronic request to refer a patient to a specialty medical provider
What can be used to verify a patient identification?
Driver's License
International Classification of Diseases, 10th revision, Clinical Modification (ICD-10-CM) codes based on the provider's diagnosis (why the patient is in need for medical services).
Diagnosis Codes
Medically necessary within 24 hours. Approx time required 20 minutes
Urgent
This piece of documentation records and tracks the patient health data, such as vitals or labs
Patient flow sheet
What are the request made by the provider based on type of payor and the services required for the patient?
Predetermination, precertification, pre-authorization, and referrals
What type of form is used for fee-for-service (FFS) Medicare beneficiaries when the service may not be covered
The Advance Beneficiary Notice of Noncoverage (ABN)
Aging report
A report that lists outstanding balances that have not been paid by either the patient or the insurance payer
Other entities
Non-patient related (depositions, sales, representatives, staff, meetings, training). Approx. time required 30 minutes
Name 2 examples of each section of a patients Medical Record (Administrative & Clinical)
Administrative: Patients demographic info, NPP, Advance Directive, Consent forms, Medical release forms, correspondence and messages, Appts. Billing info
Clinical: Health history, physical examiniations, allergies, medication record, problem list, progress notes, lab data, Diagnostic procedures, continuity of care
Electronic Health Record (EHR)
What regulation implemented changes in the reimbursement methods of payment for Part B providers?
Medicare Access and CHIP Reauthorization Act of 2015
A record of the diagnosis and procedures covered during the current visit; also known as SUPERBILL
Name all of types of office Visits
New patient, Established patient, Comprehensive, Preventative Care, Urgent, Other entities
Name 4 of 5 types of documentation used for patients
Patient flow sheet, encounter form/superbill, encounter notes, laboratory report, radiology report.
How long are diagnosis codes and what do they typically begin with?
Diagnosis codes are three to seven alphanumeric characters long and begin with a letter
Name the types of Diagnostic Procedural Codes
Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS), International Classification of Diseases, 10th revision, Clinical Modification (ICD-10-CM)