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Flashcards

Chapter 12, Medicare Medical Billing Flashcards

14399505454	Benefit Period	Length of time during which benefits are paid	0
14399506747	Consolidated Omnibus Budget Reconciliation Act (COBRA)	mandates an insurance program which gives some employees the ability to continue health insurance coverage after leaving	1
14399508643	Crossover	the transfer of processed claim data from Medicare operations to Medicaid (or state) agencies and private insurance companies that sell supplemental insurance benefits to Medicare. beneficiaries.	2
14399509822	Electronic Remittance Advice (ERA)	an electronic document that lists patients, dates of service, charges, and the amount paid or denied by the insurance carrier	3
14399513116	end-stage renal disease (ESRD)	the final phase of chronic kidney disease	4
14399515804	Healthcare Common Procedure Coding System (HCPCS)	A numeric and alphabetic coding system used for billing and pricing of procedures, medical supplies, medications, and durable medical equipment.	5
14399518490	Intermediaries	the transfer of processed claim data from Medicare operations to Medicaid (or state) agencies and private insurance companies that sell supplemental insurance benefits to Medicare. beneficiaries.	6
14399520362	limiting charge	The maximum amount a physician may charge a Medicare beneficiary for a covered service if the physician does not accept assignment of the Medicare approved amount.	7
14399522951	Local Coverage Determination (LCD)	notices sent to physicians with information about the coding and medical necessity of a service	8
14399543779	Medicare Abuse	Includes improper payments for items or services when there was no legal entitlement to that payment	9
14399544813	Medicare Advantage	Medicare Part C	10
14399546772	Medicare Administrative Contractor (MAC)	contractor who handles claims and related functions	11
14399547586	Medicare Development Letter	Medicare Development Letter A letter sent to a provider by Medicare requesting additional information or documentation to process a claim.	12
14399551286	Medicare Fraud	Providing false information to claim medical reimbursements beyond the scope of payment for actual healthcare services rendered.	13
14399552998	Medicare Part A (aka Hospital Insurance or HI)	Provides hospital insurance automatically @ age 65 (if FICA qualified) @ no fee but may have deductible & co-pay.	14
14399555991	Medicare Part B	The part of the Medicare program that pays for physician services, outpatient hospital services, durable medical equipment, and other services and supplies.	15
14399557945	Medicare Part C	Medicare Advantage Plans	16
14399560515	Medicare Part D	Prescription drug coverage	17
14399561293	Medicare Remittance Notice (MRN)	remittance advice from Medicare to providers that explains how payments for a batch of Medicare claims were determined	18
14399570869	Medicare Secondary Payer (MSP)	The primary insurance must pay for any medical care before Medicare pays.	19
14399573126	Medicare Summary Notice (MSN)	A summary sent to the patient from Medicare that summarizes all services provided over a period of time with an explanation of benefits provided	20
14399575436	Medigap	a private insurance policy that pays the difference between the medical charge and the amount that Medicare pays	21
14399576277	Non-par MFS	Non-PAR MFS Amount that applies to unassigned services performed by physicians and suppliers who choose not to participate in the Medicare program, which is 5% less than the MFS for participating providers. Providers who are non-PAR and not accepting assignment may charge a limiting charge of 115% of the nonparticipating fee amount.	22
14399583144	Office of the Inspector General (OIG)	government agency that investigates and prosecutes fraud	23
14399586522	Program of All-Inclusive Care for the Elderly (PACE)	PACE provides comprehensive medical and social services to certain frail, elderly people (participants) still living in the community. Most of the participants who are in PACE are dually eligible for both Medicare and Medicaid.	24
14399587197	Recovery Audit Contractor (RAC)	program designed to audit Medicare claims	25
14399588809	Scrubbing	The term scrubbing refers to an in-depth 'cleaning' of a medical insurance claim prior to submission. ... In an ideal situation, the insurance payer checks the claim for any errors.	26
14399590648	Tax Relief and Healthcare Act (TRHCA)	The Act provides for extensions and modifications of certain previously or soon to be expired tax relief provisions, extensions of certain expiring energy provisions, health savings account provisions and other general tax relief provisions.	27
14399591325	telemedicine/telehealth	-Delivery of medical information and clinical services through interactive audiovisual media -Part of every health care provider's training	28

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Electronic medical Billing Midterm Flashcards

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10349682564	A clustering appointment type is where patients with similar conditions are seen on the same day.	True	0
10349684309	A medical assistant can check for available exam rooms and providers using an electronic scheduling system.	True	1
10349685695	A new patient requires more time for an appointment than an established patient.	True	2
10349686808	A patient calls complaining of painful urination and blood in her urine but her physician is out for the day. The medical assistant should schedule an appointment for the next day.	False	3
10349687850	A patient complaining of burning and frequency associated with urination should be seen on the same day.	True	4
10349688673	A patient who has been vomiting off and on for several days should be sent to the emergency room rather than be seen in the medical office.	False	5
10349689521	Always ask the physician if you are unsure whether a patient should be seen right away.	False	6
10349690844	Any information relating to the past, present or future physical/mental health, or condition of an individual which resides in electronic system(s) used to capture, transmit, receive, store, retrieve, link and manipulate multimedia data for the primary purpose of providing health care and health-related services"is known as electronic medial records.	False	7
10349693319	Appointment reminder letters help to increase the number of appointment no-shows.	False	8
10349694101	Clinton signed HITECH into law.	False	9
10349695183	CPOE decreases clinician productivity and increases medication errors.	False	10
10349696850	Results Management is one of the 20 Functions of EHR.	False	11
10349705220	The appointment schedule for today is completely full. A 62-year-old patient calls complaining of having a 100°F fever and diarrhea since the previous night. She should be worked into the schedule for today.	False	12
10349706033	When scheduling a procedure such as a sigmoidoscopy, the medical assistant must consider the physician's availability as well as the availability of the exam room.	True	13
10349708336	When using an electronic scheduling system, the medical assistant must set a blocked appointment time individually for each physician.	False	14
10349709563	_______________ findings is also the chief complaint.	objective	15
10349710914	__________________ letters notify patients of no-shows, while _____________ letters inform patients of upcoming appointments.	Missed appointment, appointment reminder	16
10349712709	A patient calls complaining of chest pain and shortness of breath. The medical assistant is the only one in the medical office at the time. The medical assistant should:	tell the patient to call 911	17
10349714787	A patient's mother calls the medical office stating that her child sprained his ankle. The child should have an appointment:	on the same day	18
10349716502	A type of appointment scheduling where two patients are given the same appointment time is called:	double-booking scheduling	19
10349717967	An established patient is one who has been seen within the last ____ years.	three	20
10349719137	Dr. Martin has been called to the hospital because of an emergency and will not be able to see any patients for the rest of the day. Several patients are already in the waiting room. The medical assistant should:	explain the situation and offer to reschedule the appointment as soon as possible	21
10349721159	If the appointment schedule is set up with 10-minute time slots, a patient scheduled for a 30-minute appointment would use ____ time slots. If the appointment schedule is set up with 15-minute time slots the same patient would use ____.	three, two	22
10349725349	In _______ scheduling, patients are given a specific appointment time for the first half of the hour, leaving the second half of the hour open for walk-in patients.	modified wave	23
10349727235	It is office policy that a physician can be double-booked once every two hours. This means that once during a two hour block of time, how many patients could have the same appointment time?	2	24
10349727986	Most post-operative protocols require the patient to have their first follow-up appointment within ___ days of having the procedure.	10	25
10349728800	Post-operative appointments should be approximately _____ in length.	30 MINS	26
10349730206	The action of blocking time when a physician is unavailable is referred to as setting up an appointment:	matrix	27
10349731796	The most important consideration when scheduling a patient appointment is:	maintaining patient confidentiality	28
10349734654	The process of separating patients by the urgency of their need for care is called:	triage	29
10349735336	The sender's address on the envelope is called the ________ address.	Return	30
10349736645	The type of appointment scheduling in which three or four patients are scheduled every half hour and are seen in the order in which they arrive is called:	wave scheduling	31
10349737919	What information is contained in the signature line of a business letter?	The name and title	32
10349739119	When setting up a recurring appointment in an electronic scheduling system, the medical assistant should enter the information _______ and then indicate how often the appointment should recur.	once	33
10349740524	When should you schedule an appointment for a patient who might have a bladder infection?	The same day	34
10349741579	Which of the following documents is not a common type of patient correspondence?	Supply invoice	35
10349743218	Which of the following is not a function of practice management software?	Order entry	36
10349744883	Which of the following patients should be seen on the same day they call the medical office?	A patient who has had a fever of 103°F for three days	37
10349747215	Which portion of a professional business letter contains the purpose of the correspondence?	Heading	38