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1. Capture of past social history. 2. Capture of medication allergies. 3. The ability to send a prescription electronically. Are all applications of an EHR system.

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Capture of insurance policy number is not an application of an EHR system?

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1. Appointment scheduling 2. Charge capture 3. Collections 4. Reporting

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Practice management software?

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Clearing house

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The services that processes insurance claims is?

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Administrative.

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What type of function is submitting claims?

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Is what you will first access to determine if the patient has ever been seen at the hospital before, or whether you must register him/her for the first time.

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Master patient index?

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Eight digits ex: 08/012/2014

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How many digits are keyed when entering data on a claim for the date?

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Demographics

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What kind of data is name, address and date of birth?

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P.H.I. Protected Health Information

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Information that identifies the patient in anyway is known as ?

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National Provider Identifier number.

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A unique identifier that is required on claim forms and identifies the care provider or group practice submitting the claim is the?

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When a PCP wants to if a patient's managed care plan covers a particular surgical procedure.

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Pre-certification?

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Electronic medical records (EMRs) are a digital version of the paper charts in the clinician's office. An EMR contains the medical and treatment history of the patients in one practice. And Electronic health records (EHRs) do all those things—and more. EHRs focus on the total health of the patient—going beyond standard clinical data collected in the provider's office and inclusive of a broader view on a patient's care.

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Difference between an EMR and EHR?

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80% of the allowable fee paid by Medicare.

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Participating physicians receive ...

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Assignment of benefits

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When a policy holder signs this form it authorizes the insurance company to pay the provider directly

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They are all government plans

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What do the following plans have in common? Medicare, Medicaid, Tricare?

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Superbill

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An encounter form is also known as a ?

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1. Legally sound. 2. Medical reviewed. 3. Reviewed by physician peer group 4. Documented

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There is an unwritten law of medical insurance that means "if a procedure is not _________, then, in the view of the payer, it was not done and should not be billed.

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Participating Provider.

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A ___________ agrees to to provide medical services to a payer's policy holder according to the terms of the plan's contract?

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Hospice care, inpatient hospital stays

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Medicare A

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Dr. services, outpatient and preventative care

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Medicare B

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Medigap and Medicare Advantage, optional

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Medicare C

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Prescription Drug Coverage, optional.

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Medicare D

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Coordination of benefits guidelines.

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Which of the following ensures that when patients have more than one policy, maximum appropriate benefits are paid?

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Establish standards for keeping health care information safe.

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Describe one of HIPAA goals?

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Preauthorization.

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Confirmation from an insurance company that a service or procedure is covered under a particular plan and is approved as medically necessary BEFORE service is rendered is called?

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2

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When looking up a diagnosis code you must first look in volume?

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3-5

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ICD-9 codes have how many digits?

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Specialized computer software that performs administrative and billing procedures in the medical offices

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Practice Management software?

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Procedures that take place at the time of care, rather than at a remote location or after care is complete.

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Point of care?

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Connecting the diagnostic code to the procedure code on the insurance claim so the procedure is justfied

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Code linkage?

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Service that assists in claims processing by standardized billing and performing error checks

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Clearinghouse?

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Cost sharing requirement under a health insurance policy that stipulates the insured assumes a percentage of the costs of covered services.

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Co-insurance?

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Computerized medical record system that captures and stores data in electric form and can be transmitted to other health care locations

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Electronic Health Record?

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Method of accessing current treatment options for a disease, through electronic or remote methods.

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Clinical Decision Support?

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The amount due from the patient at the time of the office visit; typically a requirement of managed care plans.

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Co-pay?

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Through a single database, many different functions can take place and information can be shared.

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Interoperability?

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Determines the primary care insurance plans when both parents cover a child.

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Birthday Rule?

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An amount the insured must pay in a calendar or fiscal year before policy benefits begin.

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Deductible?

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Any piece of identifying or clinical information about a patient.

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Protected Health Information?

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Use of health information in a effective and efficient manner to improve patient care.

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Meaningful use?

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Code linkage

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Checking a diagnostic code against a procedure code is referred to as?

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A form generated at the completion of an office visit, a portion of which details the patients diagnosis, procedures and services performed, and charge for each procedure/service.

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Encounter form?

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Filing a healthcare claim using a computer rather than paper.

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Electronic claims submission?

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Technology that digitally transcribes spoken words.

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Speech recognition?

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Specialized computer software performs administrative and billing procedures in medical offices.

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Practice Management software?

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documented patient information such as age, sex, race

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Demographics?

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Procedures that take place at the time of care, rather than at a remote location or a at a point in time after care

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Point of care?

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Person, usually a physician, who performs healthcare services requiring specialized education and training

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Care provider?

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Service that assists in claims processing by standardizing billing and performing error checks.

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Clearninghouse?

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includes clinical documentation

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EHR/EMR software is more comprehensive than Practice Management software because it?

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1. allows for ePescribing 2. has mobile applications. 3. assists in information exhange.

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PrimeSUITE

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Once

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A patient is entered into the patient list?

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Patient flow

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The process of moving a patient from appointment making through check-out is known as called?

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Progress note

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Clinical documentation of a patient's visit is known as the?

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Superbill

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An encounter form is also known as?

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CMS1500 form

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A _____ is a form used to bill patient claims in a physician office?

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Plan of care

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Which illustrates clinical information collected through an EHR?

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Interoperability.

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________ is not easily attained when using a manual record system?

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Patient information such as blood pressure and respiratory rate.

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Vital signs?

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patient information that includes immunizations and allergies.

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Past medical history?

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patient information that includes information such as frequency of drinking and smoking.

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Social history?

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Comprehensive inventory of patient symptoms such as headaches , vision, heart palpitations, swelling of joints, etc

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review of systems?

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Patient information that includes past procedures and who performed the procedures

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Past surgical history?

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Patient information that includes possibly inherited conditions.

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Past family history?

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A field

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An on screen item of data is known as?

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Details box

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PrimeSUITE allows you to note discrepancies in the _____ box?

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Logical

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It is important to keep the design of of paper forms?

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2. Birth

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Which of the following, 1. family, 2. birth, 3. social, 4. surgical, is not a required patient history?

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1. Care providers 2. Patients 3. Receptionists

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The following will benefit from thoroughly completed paper forms

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Family

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The patient's ____ history could possibly help predict a future health condition?

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Facesheet

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A patient's vital signs are entered via PrimeSUITE's ____ screen?

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Interview

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The following is an acceptable way of gathering a patient's history:

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Allergies

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Which piece of information might be included multiplies times on a form?

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1. name 2. DOB 3. medical record number

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What information should you see on all forms in a patient's chart?

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Approximate date of the procedure

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A patient's past surgical history includes the?

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Adjacent

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For ease of completion, related information should be ___ on a form?

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Body mass index

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What does BMI stand for?

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Social history

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Which of the following would include a patient's exercise regimen?

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Documented

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Any discrepancies in patient information need to be?

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Information, such as a patient's gender and date of birth, that is required to be collected under HIPAA

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Administrative data?

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A list of correct definitions for a facility's unique terms and jargon.

answer

Data Dictionary?

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The form used to submit insurance claims in a healthcare office

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CMS-1500

question

In terms of computer software, a comprehensive listing of related entities to choose from, such as ICD-10 codes

answer

Library?

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