Compliance
What is PHI?
HIPAA FOR ONE!
Private Health Information
What is a template?
A PRE-SET document thats used as a starting point for documents that have to be consistently recreated.
What are electronic medical records (EMR)?
An electronic record of health information that is created, added to, managed, and reviewed by authorized providers and staff within a single health care organization.
What are three filing systems used for paper files?
Three filing systems are alphabetic, numeric, and by subject.
What is informed consent?
When the patient gives written approval for a procedure or test based on information presented by the provider. The process ensures that the patient is prepared to make a sound decision about her care.
What do Upcoding, and Unbundling mean?
Upcoding- Assigning a diagnosis or procedure code at a higher level than the documentation supports, such as coding bronchitis as pneumonia.
Unbundling- Using multiple Codes that describe different components of using a single code that describes all steps of the procedure.
What is Wave booking? Modified Wave Booking?
Patients are scheduled at the same time each hour to create short term flexibility each hour.
to schedule two patients to come at 9 am and one patient at 9:30 am.
Why is health insurance important?
Health insurance is important because if serves as protection against financial losses due to illness or injury. Insurance provides financial support for medical needs, hospitalization, medically necessary diagnostic tests and procedures and many kinds of preventive services?
What is the difference between a copayment and coinsurance?
The copayment is a fee collected at the time of service. Coinsurance is the percentage of health care costs the patient is responsible for after the deductible has been met.
Coinsurance-80/20
What is a deductible?
The amount of money patients must pay out of pocket before the insurance company will start to pay for covered benefits.
With whom are covered entities allowed to share information?
Covered entities are allowed to share information relevant to the patient's care with a spouse, family member, friend, or other individual identified by the patient.
True or False: Medical practices never charge for no shows.
False: Each medical practice sets policies that meets its needs. One approach is to give patients a warning, followed by a notations in the medical record, before charging them, if these strategies don't work, providers can decide to charge these patients.
What are CPT codes used to describe?
Services provided by providers
Example: Treatments/Procedures
True or False: The allowable amount is not taken into account when determining how much the patient owes.
False.
The allowable amount is addressed by wither having the provider write it off or billing the patient for the difference between the providers fee and what amount he or she is allowed to charge.
True or False: Consent is required for minors in a life- threatening situation.
False.
This is one of four exceptions when consent for minors is not required.
What is the difference between Medicare and Medicaid?
Medicare is insurance for individuals 65 and older or for those under age 65 with disabilities. Medicaid is for those considered medically indigent; States must work with the federal government to ensure eligibility criteria.
Why is it important to get pre-authorization if the patient's insurance requires you to do so?
Pre-authorization is a formal approval from the insurance company that it will cover the test or procedure. If the insurance company requires this and it is not done, the patient runs the risk of having to pay the full amount for the procedure rather that having the opportunity to make other arrangements.
What is included in accurate, up-to-date medical record?
D- All information relevant to patient medical care and insurance
How should mail be sorted?
By order of importance.
What is an explanation of benefits(EOB)?
A. Explains what services Medicare will not cover
B. The amount the patient pays after each visit
C. A document that identifies what was paid, reduced, or denied
D. The percentage of the premium that the patient must cover.
C. A document that identifies what was paid, reduced or denied.
As well as the deductible, coinsurance, and allowable amount.
What is OSHA's Mission?
To ensure workplace safety and a healthy working environment
What are the three factors that must be considered when scheduling appointments?
The three factors are the patients' needs, the providers' habits and preferences, and the availability of rooms and equipment in the facility.
What is the HIPAA notice of privacy practices form?
Medical practices are not allowed to release information unless patients first sign a notice of privacy practices form. This form explains what's in a patient's medical record the patient's health information rights (Example: Request a restriction on certain uses and disclosures of information)
A provider bought a new piece of equipment for $2,000. The office put down $500 and has a balance of $1,500. What part of the equation is the provider's assets?
A. the $500 the office put down.
B.The $1,500 the provider still owes
C. The $2,000 the provider paid for the new equipment
D. None of these sums of money are considered assets.
C-The $2,000 and the equipment it purchased are considered the provider's assets.
What information does the patient need before undergoing a medical test or procedure?
The patient needs to know the date and time of the test; what to do to prepare for test, such as eating restrictions, fluid requirements, and whether medications should be taken; and information about preadmission testing. The patient also needs to bring a form of picture identification and insurance card to the facility on the day of the procedure. They need to know whether they need to pick up orders or if they will be forwarded to the facility in advance.