CCMA NHA Module 11: Administrative Assisting

Shingling

A method of filing in which a report is laid on top of the older report, resembling the shingles of a roof.

Automated call routing

Allows a patient to confirm or cancel an appointment remotely

Upcoding

Act of unlawfully increasing a reimbursement amount from a third-party payor

Subjective medical record content

Includes a patient's demographic data, chief complaint, medical, family and social history.

Database

A collection of organized data that allows access, retrieval, and use of data

Safety Data Sheet (SDS)

Sheet that provides information on the safe use of and hazards of chemicals, as well as emergency steps to take in the event chemicals are splashed, sprayed, or ingested

Durable items

Pieces of equipment that are used indefinitely - such as telephones, computers, and examination tables, stethoscopes and reflex hammers, wheelchairs- are not considered supplies

Current Procedural Terminology (CPT) manual

Provides a standard language for reporting services provided during a medical visit

Clearinghouse submission

Allows a provider to submit multiple insurance claims electronically in batches for a small fee; uses special software to audit and sort claims for various insurance carriers

Fee schedule

A list of charges or established allowances for specific medical services and procedures

Wave scheduling

A method of scheduling patients in which multiple patients are scheduled at one same time and seen in the order they arrive at the office

Modified wave scheduling

System where multiple patients are scheduled at the beginning of each hour, followed by single appointments every 10 to 20 minutes the rest of the hour

Double booking scheduling

A type of appointment scheduling where two patients are given the same appointment time

Time-specified (stream) scheduling

Scheduling appointments at a specific time, can also be termed fixed appointment scheduling and single booking

Notice of Privacy Practices (NPP)

A legally required notice that healthcare providers and plans must distribute to their patients that outlines how their protected health information is used and disclosed, and the rights the patient has

Quality control

The processes an organization uses to maintain its established quality standards

Conditioning (filing system)

Grouping related papers together & removing all papers and staples, attaching smaller papers to regular sheets, fixing damaged record

Releasing ( filing systems)

Marking the form to be filed with a mark of designated preference (ready to be filed, the provider's initials, using a stamp)

Indexing and Coding Files

-Deciding where document is to be filed

-Weather it needs to be cross-referenced in another section

-a chart number is typically used for this.

Sorting files

Involves ordering papers in a filling structure and placing the document in specific groups

Storing and filing

Securing documents permanently in the file to ensure the medical record documents do not become misplaced

Alphabetic filing

A traditional system for patient records in providers' offices and the most widely used. Files are arranged by last name, first name and middle initial

Numeric filing

The filing of records, correspondence, or cards by number.

Subject filing

Either an alphabetic or alphanumeric code is assigned to general correspondence.

HIPAA

The Health Insurance Portability and Accountability Act, a federal law protecting the privacy of patient-specific health care information and providing the patient with control over how this information is used and distributed.

SOAP

subjective, objective, assessment, plan

SOMR (source of oriented medical record)

SOURCE ORIENTED. Medical record filing system using each document's source

POMR (problem oriented medical record)

Data is arranged according to medical issue/problem

CPOE (Computerized Physician Order Entry)

Application used by physicians and other health care providers to enter patient care information. Also provides support tools that result in improved care and patient outcomes.

Copay

A specified sum of money based on the patient's insurance policy benefits due at the time of service

Coinsurance

The sharing of expenses by the policyholder and the insurance company

Deductible

Specified amount of money that the insured must pay for covered medical expenses before the insurance policy begins to pay; usually annual amount per individual or family

EOB (explanation of benefits)

A statement sent by a third-party payer to the patient to explain services provided, amounts billed, and payments made by health plans

Remittance advice (RA)

The report sent from the third-party payer to the provider that reflects any changes made to the original billing.

Advance Beneficiary Notice (ABN)

A form provided to the patient when the provider believes Medicare will probably not pay for services received

PPO (Preferred Provider Organization)

A type of health plan that contracts with medical providers, such as hospitals and doctors, to create a network of participating providers. You pay less if you use providers that belong to the plan's network.

HMO (Health Maintenance Organization)

Health insurance that requires a PCP and wants you to use only in-network doctors. Requires referrals to specialists.

Tricare

Military health plan that provides services for active duty personnel and their families, survivors of military personnel and retired military personnel and their families

CHAMPVA

Covers surviving spouses and dependent children of veterans who died as a result of service-related disabilities

Medicare

A federal program of health insurance for persons 65 years of age and older, permanently disabled, with end-stage renal disease

Medicare Part A

The part of the Medicare program that pays for hospitalization, care in a skilled nursing facility, home health care, and hospice care.

Medicare Part B

The part of the Medicare program that pays for physician services, outpatient hospital services, durable medical equipment, and other services and supplies.

Medicare Part C

Managed care health plans offered to Medicare beneficiaries under the Medicare advantage program

Medicare Part D

Medicare prescription drug reimbursement plans

ICD-10-CM

International Classification of Diseases Coding Manual used for Professional Services (out of hospital)

ICD-10-PCS

International Classification of Diseases, 10th Revision, Procedure Coding System (in-hospital)

Healthcare Common Procedure Coding System (HCPCS)

A group of codes and descriptors used to represent health care procedures, supplies, products, and services.

Account balance

The amount in an account

Debit

An amount recorded on the left side of an account(negative)

Credit

An amount recorded on the right side of an account(positive)

Accounts receivable

The total amount of money owed to a business.

Accounts payable

Money owed by a company to its creditors.

Assets

Resources owned by a business

Liabilities

Outstanding amounts owed to others

Aging reports

Reports that show the passage of time between the issuing of a request for payment (invoice) and the receipt of payment; used to determine late payments and collect them.

CMS-1500 form

Claim form used for medical billing