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