Shared Flashcard Set

Details

MOD H 10,11
MOD H Chapter 10, 11
48
Medical
Not Applicable
09/10/2012

Additional Medical Flashcards

 


 

Cards

Term
When do PT./Staff encounters begin?
Definition
When PT. calls for appointment
Term
"Surrogates" include:
Definition
office location, size and layout
Term
How much info is a physician allowed to share with a PT.?
Definition
Only enough to relate to them
Term
65 yr old Americans:
Definition
live longer, over next 30 years, the amount of them will double
Term
Release of info to a third party:
Definition
illegal without written consent
Term
Assignment of benefits:
Definition
allows payment to go directly to the provider
Term
PT. Information Form:
Definition
contains demographics, and health insurance info
Term
Daily Journal:
Definition
chronological record of all PT. transactions
Term
One-Write or Pegboard system:
Definition
captures info at the time transaction takes place
Term
When using billing software:
Definition
create a periodic backup file
Term
Billing Cycle:
Definition
when statements are sent out periodically
Term
If a PT. has no insurance listed:
Definition
find out why
Term
Federal Truth in Lending Act of 1968:
Definition
allows installment payment plan of more than 4 payments
Term
Categories of problem debtors:
Definition
forgetful, fraudulent, and chronically slow
Term
Fair Debt Collection Practice Act:
Definition
addresses abusive methods by third party collectors
Term
Collection Agency:
Definition
arranges for payment of money owed to a third party
Term
Plantiff:
Definition
the person suing, court expects them to try settling before taking it to court
Term
Defendant:
Definition
person being sued
Term
Accounts receivable:
Definition
entire group of PT. ledgers
Term
General ledger:
Definition
the "core" of a practice's financial records
Term
PT. ledger:
Definition
chronological accounting of PT.'s activities, including charges and payments
Term
Payroll ledger:
Definition
record for wages and salaries
Term
General Journal:
Definition
chronological listing of all transactions, most basic of all office records
Term
Disbursement Journal:
Definition
listing of expenses paid out to vendors
Term
Daily Journal:
Definition
record of PT. transactions, including previous balances, charges, payments
Term
Before submitting a claim, what is necessary?
Definition
sign and dated release of information
Term
InPT. hospitalization:
Definition
typically require pre-authorization or pre-certification
Term
Reasons claims can be rejected:
Definition
incorrect ID#, invalid codes, missing EIN#
Term
Employer Identification Number (EIN)
Definition
9 digit taxpayer ID number
Term
Adjudication:
Definition
claim is reviewed and paid
Term
Insurance claims register:
Definition
recording claims information on a columnar form
Term
Remittance advice:
Definition
also known as an explanation of benefits
Term
The frequency of claims submitted can vary depending on:
Definition
size of practice, staffing and type of claim
Term
Secondary claim:
Definition
if PT.'s are covered by 2 insurances, this may need to be submitted
Term
Insurance professional should do what when a coordination of benefits situation exists?
Definition
verify primary and secondary payer
Term
Medicare claims must include:
Definition
name, Medicare number, services being appealed, date
Term
First level of a Medicare appeal is called:
Definition
appeal request for review
Term
CSM-1500, block 11d:
Definition
mark it "yes" if there is second insurance
Term
Appeal:
Definition
review from third-party, file if wrongful denial
Term
What 3 ways can you request a fair hearing?
Definition
1)personal hearing
2)telephone hearing
3)hearing on record
Term
Written appeal request must obtain:
Definition
beneficiary's name and Medicare claim #
Term
Most productive type of hearing:
Definition
hearing on record
Term
When should you verify PT.'s insurance:
Definition
everytime they come to the clinic
Term
Attachments on paper claims:
Definition
1)practice name
2)group #
3)address
4)phone #
Term
If a corrected claim is submitted for reconsideration:
Definition
mark it CORRECTED BILLING, NOT A DUPLICATE CLAIM
Term
Explanation of benefits:
Definition
gives all information regarding the charges
Term
Time limits for filing claims:
Definition
1 year
Term
Coordination of benefits:
Definition
used if a PT. and spouse are covered under 2 separate group policies
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