MOSS Unit 2 Test Study Guide

Medicare

insurance for people 65 years or older & some disabilities   

Medicaid

insurance for people from low incomes 

Medigap

a coverage that helps pay for the deductible and co-insurance and other “gaps” in coverage in the Medicare plan

Registration form

also called a patient information data sheet; filled out by the person, or guardian of the person, to be treated by the physician 

Demographics

basic information regarding the patient that includes address, phone number, date of birth, gender, marital status, employer, school, etc. 

How are demographics obtained?

patient intake forms, electronic health records (EHRs), and surveys 

New patient

an individual who has not received services from the provider, or from an associate provider of the same specialty who belongs to the same group practice, within the past three years 

Established Patient

an individual who has received professional services from the provider, or from another provider of the same specialty who belongs to the same group practice, within the past three years 

Subscriber

the primary insured who is eligible for and enrolled in a benefits plan. For example, one adult family member may be the subscriber, while his/her spouse and children are dependents of the insurance plan

Subscriber Number

also known as the insurance policy number; a unique number that is assigned to the subscriber 

Group Number

assigned by a health insurer to identify a specific set of people covered under the same insurance plan. This group could be employees of the same company, members of an organization, or people living in a certain area

Acute

sudden, severe, and short-lived, often requiring immediate attention 

Chronic

long-lasting nature of a disease or condition

Walk-In-Patient

a person who comes to the office without an appointment 

Work-In-Patient

a patient who calls the day before or on the same day that an appointment is needed 

Visit Reason

term used to identify the reason for a patient appointment 

Chief Complaint

the patient’s reason for being seen for the visit, in his own words 

Visit Type

term used to identify the type of visit for a patient appointment (e.g. new patient, physical exam, procedure, recheck, follow-up, etc.) 

What is the reason for a office visit?

Often acute problems

What is the reason for an extended office visit ?

Typically for new problems or complex issues

What is the reason for a follow up office visit ?

For rechecks on recurring issues

What is the reason for a consultation ?

A visit with a specialist to recommend care on a specific condition

What is the reason for new patient?

Used to establish a new client at the facility

What is the reason for history and physical examination?

A preventive care or maintenance visit

What is the reason for a procedure?

For a visit where a procedure will be performed

Rescheduled

changing an existing appointment to another date and time 

Cancelled

deleting an appointment without rescheduling it; this should be documented in the patient record 

Reference sheet

shows all patients scheduled for an office visit for a specified time period 

Flow boards

are patient(s) appointment status, such as the time an appointment is scheduled for, what time did the patient show up, where did the appointment occur, when did they check out 

What are some examples of the types of documentation that would need to obtained & gathered for provider review ?

• Letters from referring providers 

•  laboratory result reports 

• radiology scans or other X-ray reports 

•  EKGs, or other specialty reports and referrals 

What are some examples of check-in tasks ?

• updating the patient’s status 

• having the patient complete or update registration and acknowledgment forms 

• scanning insurance cards 

• running online eligibility reports as necessary 

Why would you need or want to update a patient’s demographic info ?

Make sure their contact details, insurance, and personal information (like address or phone number) are correct. This helps with communication, billing, and providing the right care 

What is a privacy notice

policies set forth to abide by the Privacy Rule, which protects individually identifiable health information, called “protected health information (PHI)

what type of info is contained within a privacy notice ?

discloses the privacy practices of an entity (such as a clinic) and the patient’s rights with respect to their PHI in clear language 

Primary insurance

the first insurance company that is billed for patient services 

Secondary Insurance

the one that pays after the primary has paid its portion, according to the benefits available under the secondary plan 

What is an eligibility report ?

document that shows whether a patient’s health insurance is active and what it covers 

what type of info is contained within a eligibility report?

patient’s insurance status, coverage details, copay and deductible info, policy start and end dates, insurance company name and contact info, plan type

What is uploading?

sending info to a system 

What is downloading?

getting info from a system 

Define co-payment

A fixed amount for a covered service, paid by the patient before the patient receives service from the provider

What is the protocol(s) that is/are followed when it comes to collecting co-payments from patients 

collected each time medical services are received