CMAA Chapter 3&4 Review

What are the three types of filing systems used in medical practices?

Alphabetical, Numeric, Subject

What is a direct filing system?

A system in which the only information needed for filing and retrieval is a patient's name

What is cross-reference?

Reference to corresponding information in a separate location

How can information be organized within patient charts so that information is easy to find?

Put similar topics together, For example, all clinical notes should be in one section, and lab reports in another

What is a copayment?

A fixed fee for a service or medication, usually collected at the time of service or purchase

What is a deductible?

The amount a patient must pay before insurance pays anything

What is coinsurance?

A form of cost sharing that kicks in after the deductible has been met

What is an encounter form?

A document used to collect data about elements of a patient visit that can become part of a patient record or be used for management purposes

What is individually identifiable health information?

Documents or bits of information that identify the person or provide enough information so that the person can be identified

What is a EHR?

An electronic record of health-related information abut a patient that conforms to nationally recognized standards and can be reviewed by authorized providers and staff from more than one health care organization

What is a 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 is meant by an "allowable amount"?

The limit that most insurance plans put on the amount that will be allowed for reimbursement for a service or procedure

What is a "fee-for-service" model?

Providers set the fees for procedures and services

What is a "EOB"?

Explanation of benefits is sent from the insurance with the record of provider and patient fees

What is a "RBRVS"?

Resource-based relative value scale is a system that provides national uniform payments after adjustments across all practices throughout the country

What is a "guarantor"?

Person or entity responsible for the remaining payment of services after insurance has paid

What is a "daily journal"?

A chronological record of bills received, bills paid, and payments and reimbursements received

What is a "day sheet"?

A daily record of financial transactions and services rendered

What is an "invoice"?

A document that describes item purchased or services rendered and shows the amount due

What is the "petty cash fund"?

A small amount of cash available for expenses such as postage, parking fees or emergency supplies needed immediately

What are "liabilities"?

The equity of those to whom money is owed (creditors)

How should mail be sorted?

By order of importance

What is a insurance "premium"

The amount you must pay for insurance coverage

When was HIPPA enacted?

1996

What is PHI?

Protected Health Information

What is OSHA's mission?

to prevent work-related injuries, illnesses and deaths

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

What are three things that must be in an emergency preparedness plan?

An emergency preparedness plan should include information about how to inform patients and employees about an emergency, how to evacuate, and who should be left behind to monitor critical equipment before evacuating.

How does HIPAA protect patients?

HIPAA protects patients by giving them more control over their medical records

What is a firewall?

a part of a computer system or network that is designed to block unauthorized access while permitting outward communication

What is upcoding?

Assigning a diagnosis or procedure code at a higher level than the documentation supports

What is a medical necessity?

The documented need for a particular medical intervention.

What is program abuse?

Practices that, either directly or indirectly, result in unnecessary costs to government-funded programs

What is Medigap?

A private health insurance that pays for most of the charges not covered by Parts A and B

What is fraud?

Making false statements of representations of material facts to obtains some benefit or payment for which no entitlement would otherwise exist