Dental Terminology chapter 20

HIPAA

Health Insurance Portability and Accountability Act

What are some of the rights that the HIPAA gives to a patient

This law gives the patient the right to obtain, review, and make correc- tions (if appropriate) of the information collected. Doctors, dentists, hospitals, clinics, and those who provide services to the patient must give written notice of how the patient records will be safeguarded and cared for.

incoming calls

phone calls received by the dental facility:

inquiry

call requesting information, such as a question about a statement or test results.

emergency

call requesting immediate attention for treatment or care.

professional

call regarding particular care or concern in patient matters.

outgoing calls

calls made from the dental facility personnel or an automated calling/appointment service:

confirmation

call to confirm an upcoming appointment.

ordering

call to a supplier or store to place an order.

collection

call to arrange payment for an outstanding statement.

answering machine

device used to record incoming messages when no one is available to answer the phone, including automatic routing for particular calls, mailbox recording for specific personnel, and voice- mail for the office

answering service

professional service that will answer phone calls and take messages, forward messages, and advise patients of working hours and availability.

conference call

telephone service in which more than two persons at different locations may converse on the phone in the same conversation.

first-class mail

letters, postcards, statements, business reply, and larger marked envelopes.

second-class mail

periodicals, magazines, and newspapers.

third-class mail

catalogs, circulars, books, and printed material weighing less than one pound.

fourth-class mail

printed matter or parcels weighing more than a pound; also called parcel post.

certified mail

postal fee service that records mail delivery by dating, numbering, and recording mailed pieces. The sender may track the progress of the mail using the receipt number.

C.O.D. mail (cash on delivery)

fee service in which a postal employee collects money at the time of delivery.

express mail

fast, 24-hour delivery of mail.

priority mail

mail delivery within two to three days.

insured mail

postal fee service insures item sent for a set price declared by the sender.

registered mail

postal fee service to record and protect mail to delivery site; postal office supplies proof (card) that material has been received; generally used for important papers.

restricted delivery

mail delivered only to person specified.

signature confirmation

requires signature of recipient upon delivery. special delivery: swift delivery of mail by the post office when received at the local station; fee for service.

special handling

delivery of third and fourth class at fastest method but does not special deliver.

e-mail

communication by means of computer.

fax

communication by telephone line connection.

text message

immediate delivery of written text by means of telephone communication.

ground package service

parcels or packages containing dental cases, returns, items to be repaired, and so forth may be sent by FedEx, UPS, or USPS. Pickup service can be arranged. USPS provides package delivery using priority, parcel, media, or library rates and flat-rate boxes and containers of varying size and expense.

online postal services

includes stamp purchase, calculation of postage, print- ing of labels, proof of delivery, and tracking of postal matters.

incoming mail

mail that has been delivered to the dental facility:

invoice

printed from supplier regarding orders received by a facility; may or may not be a demand for payment.

statement

request for payment for services, products, or material received by a facility.

miscellaneous

may include lab reports, general information or corre- spondence, meeting information, samples, or advertisements.

packages

may be from dental laboratories, suppliers, or sample products.

personal

mail meant for a specific individual, not general business communications.

payment

envelopes containing checks as payment for statement or treat- ment received.

outgoing mail

mail that is sent from the facility; may be sent as first class, special delivery, priority, registered, or certified.

ZIP code

specific numbers assigned by the postal office to designated areas of the country.

appointment

period of time set aside for a scheduled patient.

appointment card

printed reminder of patient's next appointment day and time.

appointment entry

recording patient's name, procedure, phone number, and other required data into a computer program or schedule book for a specific time and day.

buffer period

open unit or block of time that is maintained on the schedule page; used for emergencies or to make up time when running behind schedule.

call list

list of patients willing to be summoned at first available opening or when cancellations occur.

daily schedule

copy of schedule of patients and procedures for the day. Copies are placed in strategic places for easy reference.

dovetail scheduling

process in which appointment times may be scheduled into the day's procedures at a "down" period of another appointment. For example, suture removal for one patient may be scheduled during the waiting period of anesthesia onset of another patient.

matrix

pattern of work periods available for appointment scheduling. Non- working hours, meetings, holidays, vacations, or any time the practice will not be in service are marked off the schedule.

recall list

system of monitoring patients' return to the dental facility. Patient is listed in the month of the desired service and called or notified at that time to make an appointment.

unit

section of an hour, may be 10, 15, or 20 minutes. Each procedure is allot- ted a specific amount of units for scheduling purposes.

patient information chart

questionnaire filled out by the patient, giving nec- essary data for office records; usually divided into general or personal, medical, insurance, and financial information queries. This information inquiry is also called a patient registration form (Figure 20-2A).

clinical chart

printed chart showing anatomical drawings and diagnostic re- sults of clinical observations; also may record procedures, fees charged, and payments received.

consent form

printed form signed by patient or guardian of a minor giving permission for treatment.

health history form

printed questionnaire regarding patient's present and past health history, medications taken, allergies, and other health matters (Figure 20-2B).

insurance information form

printed questionnaire regarding insurance pol- icy, numbers, type, and any other data supplied on the insurance card.

credit card/credit insurance registration

patients who plan on using credit card services or CareCredit insurance plans may want to record data and provide signatures. Others may want to make financial arrangements at this time or in the future.

patient file envelope

large file envelope used to gather and hold together all of the patient records in one central location. Folders may be color-coded to aid in file placement and retrieval.

file cabinet

horizontal or vertical drawer cabinets that hold files; also, open- faced cabinets with clear access to records and more visible color-coding, and space-saving rotary files that rotate records for retrieval access.

file folder

thick envelope or tabbed folder used to contain patient records and notes or other grouping of items. Tab positions may be arranged with three divisions (left, middle, right) or four divisions, called cuts.

file guide

heavy cardboard sheet with letter, numbers, or subject matter on tabs; used to divide file drawer into sections.

out card

bright-colored card that is put into the place where a file is removed to ensure proper placement when the file is returned; may also have entry table to indicate location of the file that was removed.

alphabetical

filing material according to the order in the alphabet. This is the most common method of filing.

chronological

filing material according to date of occurrence; this method may be used for recall appointment or inventory scheduling and other time-related procedures.

geographical

filing material according to location, such as street, town, state. This method may be used in large cities or practices with branch offices.

numerical

assigning material to a number and filing according to number sequence. This method may be used for procedures or study models. The system requires a numerical access book, listing numbers with names.

subject

filing material according to subject matter, such as utility bills or products.

color-coding

using color folders or tabs to indicate status, department, or anyother separation desired.

coding

identifying the file alignment with marks, numbers, or color changes to aid in rapid placement and retrieval.

indexing

the process of identifying the position for placement of an item into the file system. Indexing requires breaking down names or titles into units and identifying the arrangement order of the units.

releasing

the process of identifying the readiness of an item to be placed into a file system. Each facility determines its individual method.

retrieving

the process of obtaining a file, using the procedural method of locating, removing, and returning, for that file system.

purging

systematic process of reviewing and removing outdated or inactive files. sorting: the process of arranging files in preparation for indexing or classifying. This step simplifies the placement effort.

transferring

the task of moving a file folder from one file system to another, for example, from the active file to the inactive file station.

letters

written correspondence between two or more parties. The content of the letter may be of assorted subjects such as insurance reviews, referrals, thank-yous, inquiries regarding supplies or statements, case studies, news announcements, birthday regards, recalls, and other items.

postcards

small, heavy paper card that carries a message on one side and the name and address of the person receiving the card on the other; used for recalls, birthday greetings, and announcements.

memos

written correspondence that is less formal than letters and is a fre- quent means of communication within a practice or in a group setting. Date, message sender, and referenced subject matter appear at the top, followed by comments.

dateline

on letterhead, stating date of correspondence. If letterhead paper is not used, the address of the sender is inserted above the dateline.

inside address

name, title, street, and city with state and ZIP code of person who will receive the correspondence.

salutation

greeting (Dear Sir or Madam).

body of letter

paragraphs that state the nature of the correspondence.

complimentary close

ending line such as "Sincerely yours."

signature line

printed name of the person who is sending and signing the letter.

title line

title of person sending letter; placed immediately below the printed signature line.

reference initials

initials of person sending the letter (in large case letters) and initials of person preparing the letter (in small case letter). Initials are separated by a slash or colon. Some offices include only the initials of the preparer and the sender's signature.

enclosure line

line that indicates material enclosed with letter; multiple enclosures are so marked (e.g., Enclosures: 3).

Dental insurance is a cooperative arrangement between what 2 parties?

The patient—subscriber or insured person

The provider, or dentist

The insurance company, carrier

usual, customary, reasonable fee (UCR)

benefits are percentages of the UCR determined through survey and research of local dentists' fees. For example, 80% of three surface amalgam restorations would be 80% of the regional UCR fee for that procedure.

table of allowance

insurance company policy establishes a specific amount for a specific service. The patient is responsible for any difference in fees between the cost of the service and the table of allowance fee.

fixed fee

fixed schedule of fees for specific services determines the amount of benefits received. The provider agrees to accept this amount as full cost. Fixed fees are usually federally mandated, for example, Medicaid.

Health maintenance organization (HMO)

The provider and patient must belong to the plan that offers specific services to members and a stipulated payment allotment to the provider regardless of the amount of procedures completed; also called closed panel dentistry.

Preferred provider organizations (PPO)

The employer, group, or organization contracts with the provider for lower-than-usual rates on dental services. The group or organization in return publicizes and encourages members to avail themselves of this program. The provider receives more patients and increased clientele in exchange for discounted fees.

Exclusive provider organization (EPO)

The EPO is similar to the PPO program with the exception that the subscriber is offered service from only dentists who are members of the provider network.

What are the three principal types of capitation plans?

HMO,PPO, EPO

Workers' compensation

covers employees injured at the working site or in fulfillment of their occupation; individual state regulated and administered.

Medicaid

low-income and qualified persons receive medical treatment or care, with prior authorization, except in emergencies, in which case treatment is provided without waiting for approval; state-administered program, and each state sets its own guidelines.

Medicare

health care for patients over age 65 who have registered for care.

Medicare Part A (aka Hospital Insurance or HI)

hospital care—inpatient services in hospital, skilled-care facilities, hospice, and home health care.

Medicare Part B

physician care—doctor service, outpatient care, some pre- ventive care; patients may be responsible for a deductible amount; some doctors accept assigned fees.

Medicare Part C (Medicare Advantage)

provides extra health-care coverage with additional patient premium costs; provides benefits under plan A and B, emergency care, and urgent care; some offer vision, dental, and wellness, and may also offer HMO, PPO, and Private Fee for Services plans (PFFS).

Medicare—Part D Prescription Drug Coverage

covers pharmacy costs in two manners: Medicare Prescription Drug Plan (PDP) or Medicare Advantage Plan (HMO or PPO); must have part A and B. Restorative dentistry and most other dental care is not covered by Medicare, with the exception of some hospital surgical care and some prescription needs.