Appointment time!
How are telehealth encounters determined?
type of medical specialty
type of service required to treat the patient
provider preference
patient preference
third-party payer guidelines allowed
what codes are the reason for the visit, such as tonsillitis or an annual exam.
The diagnosis code(s) (ICD-10-CM)
Healthcare Common Procedure Coding System codes that identify supplies and procedures not described by CPT codes.
HCPCS codes
Clinical notes that include history of present illness and current medications list
Encounter Notes
How should the CCMA handle an emergency situation on the phone?
he patient can be asked to call 911 or the MA can call 911 themselves to request personnel go to the patient’s location, remaining on the phone with the patient until EMS personnel arrive
What does “screening” refer to?
asking questions to determine the patient’s signs and symptoms as well as the history of the current condition to prioritize the medical services
What kind of services may require a utilization review before being scheduled or provided?
Elective and costly procedures
Therapies
diagnostic imaging
Prescriptions
laboratory tests
What can patient financial responsibility include? (3)
Copayment
Coinsurance
deductible
Records the diagnosis and procedures covered during the current visit- what is this document called?
Encounter Form/Superbill
How are corrections made to a paper record?
adding a correcting entry or addendum or by drawing a line through data and adding new data—it should never be permanently deleted
What types of questions can be asked during the screening process?
patient name
Patient contact information
reason for the visit
nature of the current condition
other health care–related questions that relate to the nature of the current condition
Codes that include what medical services were provided, such as an exam or laboratory work.
The procedure code(s) (CPT®)
What must be used to ensure that electronic referral forms are safe from unauthorized access when being sent to the specialty provider?
Encryption
What does the clinical portion of a medical record include?
Health history
Physical exams
Allergies
Medication record
Problem list
Progress notes
Laboratory data
Diagnostic procedures
Continuity of care
What information should be gathered at the beginning of an emergency call?
patient their name
phone number
location
What is a “decision tree”?
has questions and directs the correct action to take depending upon the responses
Approval of insurance coverage and necessity of services prior to the patient receiving them.
pre authorization
Why are referrals considered part of the HIPAA exclusions for Treatment, Payments, and Operations (TPO)?
Compliance purposes
Records and tracks patient health data, such as vitals or lab results is what document ?
Patient Flow Sheet
Information that includes follow-up appointments, provider orders, instructions, educational resources, and financial account information.
After-Visit Summary (AVS)
What must be asked of the patient after the screening process is complete?
verify the third-party payer (insurance) information and eligibility
A request to determine if a service is covered by the patient’s policy and what the reimbursement would be.
precertification
Current Procedural Terminology codes that identify medical services and procedures performed by a provider.
CPT codes
What does the administrative portion of a medical record include?
Patient’s demographic data
Notice of privacy practices
Advanced directive
Consent forms
Medical release forms
Correspondence and messages
Appointments and billing information
What is a co-payment?
A set amount determined by the plan/payer that the patient pays for specified services, usually office visits and emergency department visits.