Patient Scheduling and Health Information Management

A comprehensive set of vocabulary flashcards focusing on patient scheduling, health information management, and various medical administration concepts.

Modified Wave Booking

Scheduling two patients to come at 9 a.m. and one patient at 9:30 a.m., repeated throughout the day.

Double Booking

Two patients are scheduled to come at the same time to see the same physician.

Stream/Time-Specific Scheduling

Scheduling patients for specific times at regular intervals based on the reason for visit.

Open Booking (Tidal Wave Scheduling)

Patients come in at intermittent times, seen in the order they arrive.

Cluster or Categorization Booking

Booking a number of patients with specific needs together at the same time of day.

Factors Influencing Scheduling

Effective scheduling considers the needs of the patient, provider habits, and facility capacity.

Computer Scheduling Advantages

Displays available times, length and type of appointment, and day/time preferences.

Protected Health Information (PHI)

Information about health status or healthcare that can be linked to a specific individual.

Health Insurance Portability and Accountability Act (HIPAA)

Legislation designed to protect the privacy and security of patient information.

Privacy Rule

Establishes protections for the privacy of an individual's health information.

Notice of Privacy Practices

Document informing a patient of when and how their PHI can be used.

Incidental Exposure

Secondary use of info/PHI that cannot be reasonably prevented and occurs from another permitted use.

Record Retention

Patient records must be kept for a specified duration, typically 2 years after death.

Audit Trail

Security measure that traces who accessed electronic info and what changes were made.

Matrix

A grid with time slots blocked out when physicians are unavailable.

Template

A preset document format used as a starting point.

Appointment Cards

Used to remind patients of scheduled appointments and eliminate misunderstandings.

Advance Directive Form

Document outlining what treatment a patient wants if they can't speak for themselves.

Health History Form

Asks patients to list illnesses, surgeries, medications, chronic issues, and allergies.

Assignment of Benefits (AOB) Form

Authorizes health insurance benefits to be sent directly to providers.

Patient Financial Responsibility Form

Confirms patient responsibility for payments to the provider.

DNR Form

States that the patient does not want to be revived after a life-threatening event.

Encounter Form

For collecting data about elements of a patient visit.

Referral Forms

Include Regular, Urgent, and STAT referrals based on urgency.

HCPCS

Codes and descriptors representing health care procedures, supplies, products, and services.

CPT

Current Procedural Terminology, used to report provider services for reimbursement.

ICD-9-CM and ICD-10-CM

Used to track a patient's diagnosis and clinical history.

Modifiers

Added information to change procedure or service descriptions in codes.

Reimbursement

Payment from insurance companies for services provided.

Upcoding

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

Unbundling

Using multiple codes for different components instead of a single code.

Fee-for-Service

Model where providers set fees for procedures and services.

Allowable Amount

Limit set by insurance plans on reimbursement for services.

Explanation of Benefits (EOB)

Record of a patient's fees and insurance payments/ an insurance company's statement that describes the costs involved for visits to your doctor or clinic

RBRVS

Resource-based Relative Value Scale, providing uniform payments adjusted across practices/assigns a value to each medical procedure, taking into account the resources used to provide the service, including physician work, practice expense, and malpractice insurance. 

Encoder Software

Assists in optimizing the reimbursement/billing process.

Bookkeeping

Part of accounting functions, including recording and summarizing financial transactions.

Copayment

Fixed fee collected from the patient at the time of service can be collected before or after but usually before

Deductible

Amount a patient pays before insurance coverage begins.

Coinsurance

Cost sharing that applies after the deductible has been met.

Statement

A request for payment from the patient.

Accounts Receivable Ledger

Document with detailed information on charges, payments, and amounts owed.

What is a Day Sheet?

A Day Sheet is a detailed daily record used primarily in accounting to track all financial transactions and services rendered by a business on a particular day. It includes the date, client information, type of services provided, amounts charged, payments received, and any outstanding balances. This document is essential for managing cash flow, reconciling accounts, and preparing financial statements.

End-of-Day Summary

Document of proof regarding accounts receivable/These summaries are crucial for monitoring practice performance, ensuring financial accuracy, and providing a clear handover of information for incoming staff. 

Single-Entry System

Bookkeeping method using one-sided accounting entries.

Double-Entry Bookkeeping

System where each entry requires an opposite entry in a different account.

Assets

Properties owned by a business.

Equities

Remaining assets after subtracting creditors' liabilities.

Health Insurance

Financial support for medical needs, including preventive services.

Medicare

Federally funded health insurance for those 65+, certain disabilities, and end-stage kidney disease.

Guarantor

Person responsible for remaining payments after insurance coverage.

Birthday Rule

Health plan of the parent whose birthday comes first is primary.

Screening System

Procedures prioritizing urgency for patient calls.

Certified Mail

First-class mail with added tracking and insurance benefits.

First-Class Mail

Sealed/unsealed material including letters and postcards.

Priority Mail

First-class mail weighing more than 13 ounces.

Standard Mail

Includes advertising and promotional materials.

Insured Mail

Mail with insurance coverage against loss or damage.

Registered Mail

Mail of all classes protected by registering.

Packing Slip

List of items in a package.

Electronic Medical Record (EMR)

Electronic record created and managed by authorized providers in a single healthcare organization.

Electronic Health Record (EHR)

Health-related info about a patient, managed across multiple healthcare organizations.

Active Files

Files of patients currently receiving treatment.

Inactive Files

Files of patients not seen for 6 months or more.

Closed Files

Files of patients who have died, moved, or terminated their relationship.

Purging

Moving a file from active to inactive status.

Direct Filing System

System using a patient's name for filing and retrieval.

Cross-Reference

Reference to information in a separate location.

OSHA Form 300 and 300A

Log and summary of work-related injuries and illnesses.

OSHA Form 301

Injury and illness incident report.

Record Keeping

Work-related injuries must be kept on file for at least 5 years.

Exposure Control Plan

Plan detailing tasks for risk of exposure to infectious materials.

Needlestick Safety & Prevention Act

OSHA Act to reduce the risk of bloodborne pathogen exposure.

Bleach Solution

Recommended 1:10 ratio of bleach to water.

Established Patient

A patient seen within the last 3 years.

Comprehensive Visit

A patient visit that can last 30-40 minutes.

What is the UB-04 form?

The UB-04 form, also known as the CMS-1450, is a standardized institutional claims form used by healthcare providers to bill for services rendered to patients. This form is primarily utilized by hospitals, skilled nursing facilities, and other institutional providers to submit claims to Medicare, Medicaid, and private insurers. The UB-04 includes essential information such as patient demographics, services provided, diagnosis codes, revenue codes, and the total charges. It ensures accurate and efficient billing processes and helps facilitate the reimbursement of services by detailing all relevant service information

What is the CMS-1500 Form?

The CMS-1500 Form is a standard claim form used by healthcare providers to bill Medicare, Medicaid, and other insurers for outpatient services. Designed primarily for individual practitioners, it captures essential patient information, including demographics and insurance details, as well as the specifics of the services rendered. Key components of the CMS-1500 Form include:

• Patient’s name and address

• Provider’s National Provider Identifier (NPI)

• Date of service and diagnosis codes for the treatment provided

• Charges for services and the amount being billed
  This form ensures accurate processing of claims and reimbursement, facilitating efficient communication between healthcare providers and payers.

Account Collections

Accounts over 91-120 days are turned over to collections.

Pre-Lab Instructions

No food or water 8-12 hours before tests.

Provisional Diagnosis

Temporary or working diagnosis.

What is Differential Diagnosis?

Differential Diagnosis is a method used by healthcare professionals to identify a patient's condition by systematically weighing the probabilities of multiple possible diseases based on symptoms, medical history, and test results.

Consent

Patient's permission for treatment.

What is Double-Entry Bookkeeping?

A system where each financial transaction is recorded in two accounts: one debit and one credit

About

What is an Accountable Care Organization (ACO)?

An Accountable Care Organization (ACO) is a group of healthcare providers, such as hospitals and physicians, who voluntarily collaborate to deliver coordinated, high-quality care to patients. The primary goal of an ACO is to improve patient outcomes while reducing overall healthcare costs. ACOs emphasize preventive care, efficient resource management, and accountability for the quality of care provided. Key components of ACOs include:

• Collaboration among providers to streamline care delivery
• Focus on patient-centered practices and improved healthcare experience
• Shared savings incentives that reward providers for meeting performance metrics and reducing costs

By fostering teamwork and accountability, ACOs aim to enhance health outcomes and patient satisfaction while controlling expenditures.