NCCT Admin Duties
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109 Terms
Is an appointment record considered legal documentation?
Yes; record visits, cancellations, and no-shows accurately.
How should an error on a paper appointment book be corrected?
Single line through it; document correction and details, never correction fluid.
What does NS mean in an appointment record?
No-show.
What is open-hours scheduling?
Walk-ins seen generally in order of arrival, except emergencies.
What is the main drawback of open-hours scheduling?
Long patient waits and possible provider downtime.
What is time-specified or stream scheduling?
Each patient gets an individual time slot.
What is wave scheduling?
Several patients booked at the beginning of a time block.
What scheduling method fits three patients booked at the same time?
Wave scheduling (the study guide's exam example).
What is modified-wave scheduling?
Appointments early in a block, with later catch-up time.
What is double-booking?
Two or more patients booked for the same slot.
What is cluster scheduling?
Group similar visits at the same part of a day or week.
What is advance scheduling?
Book appointments weeks or months ahead.
What is combination scheduling?
Use more than one scheduling method.
What is a scheduling matrix?
Provider calendar with appointment slots and blocked times.
How long is a typical minor office visit in the guide?
Often about 15 minutes.
How long might a physical exam or procedure appointment take?
Often 30 to 60 minutes.
What should a specialist referral include?
Patient information, reason for referral, and requested follow-up.
What does an in-network specialist mean?
A specialist participating in the patient's insurance network.
What does S mean in SOAP?
Subjective: patient-reported symptoms and concerns.
What does O mean in SOAP?
Objective: measurable findings, vitals, and test results.
What does A mean in SOAP?
Assessment: provider's impression or diagnosis.
What does P mean in SOAP?
Plan: treatment, education, orders, and follow-up.
Which SOAP section includes a patient's report of pain?
Subjective (S).
Which SOAP section includes a measured blood pressure?
Objective (O).
Which SOAP section includes the provider's diagnosis?
Assessment (A).
Which SOAP section includes planned medication and follow-up?
Plan (P).
What is the most common paper filing system in the guide?
Alphabetic: last name, then first name and middle initial.
What is numeric medical record filing?
Assign a patient number; use a master name-number index.
What is an EHR?
Electronic health record.
What does HITECH relate to in the guide?
Federal promotion of electronic health record adoption.
What is a web-based EHR?
Record system hosted online and maintained by a vendor.
What is a fully integrated EHR system?
Links records, scheduling, lab results, medications, and billing.
What is point-of-care data entry?
Entering patient information during the encounter using a device.
What does COW stand for in office technology?
Computer on Wheels.
What are demographics in a patient database?
Patient identifying and contact information.
Which code system stores diagnosis information in a database?
ICD-10-CM.
Which code system stores office procedure information?
CPT.
What are transactions in a medical office database?
Charges, payments, and adjustments.
What is full-block business letter formatting?
All letter contents left aligned.
What is modified-block letter formatting?
Date and closing centered; other content left aligned.
What is semi-block letter formatting?
Date/close centered; each paragraph first line indented.
What is hanging-indentation letter formatting?
First line left; later lines of each paragraph indented.
What is simplified letter formatting?
All content left aligned; no greeting or complimentary close.
What is a standard business envelope called?
No. 10 envelope.
What does MCO stand for?
Managed Care Organization.
What does HMO stand for?
Health Maintenance Organization.
What does EPO stand for?
Exclusive Provider Organization.
What is a key feature of an EPO?
Usually requires in-network care, with emergency exceptions.
What is a key feature of an HMO?
Managed provider network and member premiums/copays.
What is a closed-panel HMO?
The HMO employs its physicians.
What is an open-panel HMO?
The HMO contracts with participating providers.
What is capitation?
Provider payment based on enrolled members, not per visit.
What does PHO stand for?
Physician-Hospital Organization.
What is a PHO?
Hospital and physicians contract together with managed care plans.
What does Medicare generally cover?
Eligible older adults and certain people with disabilities.
Who administers Medicare?
Centers for Medicare & Medicaid Services (CMS).
What does Medicare Part A generally cover?
Inpatient hospital care and qualifying facility/home services.
What does Medicare Part B generally cover?
Physician/outpatient services and certain medical equipment.
What is Medigap?
Private supplemental insurance for Medicare beneficiaries.
What does accepting Medicare assignment mean?
Accept the Medicare-approved amount as full payment for the service.
What is the usual Medicare Part B approved-charge split in the guide?
Typically 80% Medicare and 20% patient, after deductible.
What is Medicaid?
Federal-state funded health coverage with state-dependent eligibility.
If a patient has Medicare and Medicaid, which is generally billed first?
Medicare.
Who may qualify for TRICARE in the guide?
Eligible military families, retirees, dependents, and some survivors.
Who may qualify for CHAMPVA in the guide?
Certain families or survivors of veterans with qualifying disabilities.
Can a person be covered by both TRICARE and CHAMPVA?
The guide states no.
What is a self-insured health plan?
Employer/organization funds health claims using its own plan money.
What does UCR stand for in medical billing?
Usual, Customary, and Reasonable charges.
What does ICD-10-CM identify?
Diagnoses, illnesses, injuries, and reasons for care.
What does CPT identify?
Professional medical services and procedures.
What does HCPCS Level II commonly identify?
Supplies, equipment, and services not described by CPT.
Which code system should identify hypertension on a claim?
ICD-10-CM.
Which code system identifies an office visit or EGD service?
CPT.
What is the claim form for a physician office visit?
CMS-1500.
What form is used for hospital facility claims?
UB-04, also called CMS-1450.
What does EOB stand for?
Explanation of Benefits; explains how a claim was processed.
What does ABN stand for?
Advance Beneficiary Notice of Noncoverage.
What is a clearinghouse in medical billing?
Reviews electronic claims before forwarding to the payer.
What may happen if diagnosis or procedure codes are incorrect?
Claim denial or delayed payment.
What is unbundling in medical billing?
Separately charging items that should be included together; can be fraudulent.
What is a bundled payment?
One payment for an episode of care.
How many digits are in a CPT code?
Five digits.
Which CPT category commonly starts with 99?
Evaluation and Management.
Which CPT category commonly starts with 7?
Radiology.
Which CPT category commonly starts with 8?
Pathology and Laboratory.
Which CPT category commonly starts with 0?
Anesthesia.
Which CPT category commonly starts with 1-6?
Surgery.
What type of codes does ICD-10-CM use?
Alphanumeric diagnosis codes.
What is the purpose of an X placeholder in ICD-10-CM?
Holds a position for the required code structure.
What is the purpose of the seventh character on some ICD-10-CM codes?
Adds encounter or other required detail.
Which coding system is for inpatient hospital procedures?
ICD-10-PCS.
Which codes does the review expect for general procedure prior authorization?
ICD-10-CM diagnosis + CPT procedure.
Which codes does the review expect for medical equipment prior authorization?
ICD-10-CM diagnosis + HCPCS Level II.
Do all outpatient diagnostic tests need prior authorization?
No; requirements depend on the test, plan, and payer.
What does the C in CHEDDAR stand for?
Chief complaint.
What does the H in CHEDDAR stand for?
History.
What does the E in CHEDDAR stand for?
Examination.
What does the first D in CHEDDAR stand for?
Details.
What does the second D in CHEDDAR stand for?
Drugs and dosages.
What does the A in CHEDDAR stand for?
Assessment.