question

medical informatics

answer

the use of computers and computer technology in health care and its delivery

question

clinical

answer

relating to or based on work done with real patients; of or relating to the medical treatment that is given to patients in hospitals, clinics, etc.

question

Special purpose applications

answer

the use of information technology for applications, such as drug design and education

question

Administrative applications

answer

use of information technology for tasks such as office management, finance and accounting and materials management

question

Practice management

answer

software that enables an office to do administrative tasks such as scheduling and accounting electronically

question

telemedicine

answer

the delivery of health care over telecommunications lines

question

database

answer

a large organized collection of information that is easy to maintain, search and sort

question

Database management software (DBMS)

answer

application software that allows the user to enter organized lists of data and easily edit, sort, and search them

question

file

answer

a practice can store all of its data and information in a database file stored on a computer. Within the file, there can be several tables.

question

table

answer

in a relational database, each table holds related information

question

records

answer

a table is made up of related records; each record holds all the information on one item in the table

question

key field

answer

uniquely identifies each record in a table

question

DRG (diagnosis related group)

answer

code used for diagnosis; hospital reimbursement by insurers is based on a formula using DRGs

question

ICD

answer

(International Classification of Diseases) codes 1,000 diseases

question

CPT

answer

(current procedural terminology) codes laboratory tests, treatments and other procedures

question

superbill

answer

encounter form

question

Encounter form

answer

(superbill) list of diagnoses and procedures common to a practice

question

electronic health record

answer

(EHR) electronic record of patient health information generated by one or more encounters in any care delivery setting

question

MEDCIN

answer

provides 250,000 codes for such things as symptoms, patient history, physical examinations, tests, diagnoses, and treatments. MEDCIN codes can be integrated with other coding systems

question

SNOMED (Systematized Nomenclature of Medicine)

answer

provides a common language that enables a consistent way of capturing, sharing, and aggregating health data

question

LOINC (Logical Observation Identifiers, Name, and Codes)

answer

standardizes laboratory and clinical codes

question

Charges

answer

the amount a patient is billed for the providers service

question

Payments

answer

made by a patient or an insurance carrier to the practice

question

Adjustments

answer

a positive or negative charge to a patient account

question

Transactions

answer

charges, payments, and adjustments

question

guarantor

answer

the person responsible for payment of a medical bill; it may be the patient or a third party

question

schedule of benefits

answer

a list of those services that the insurance carrier will cover

question

indemnity plan

answer

fee for service health insurance plan

question

fee for service plans

answer

health insurance plans that are not restricted to a network of providers; they do not need referrals to specialists

question

deductible

answer

a certain amount the patient is required to pay each year before the health insurance begins paying

question

managed care

answer

a type of health insurance that requires the patient to choose among a network of providers

question

preferred provider organizations (PPOs)

answer

a patient with PPO insurance can seek care within an approved network of health care providers who have agreed with the insurance company to lower their charges and accept assignment

question

authorization

answer

permission by the insurance carrier for the provider to perform a medical procedure

question

assignment

answer

the amount the insurance company pays

question

co-payment

answer

the part of the charge for which the patient is responsible

question

Centers for Medicare and Medicaid Services (CMS)

answer

government insurance plans are administered by the federal Centers for Medicare and Medicaid Services (CMS), formerly the Health Care Financing Administration (HCFA)

question

Workers Compensation

answer

a government program that covers job-related illness or injury

question

Medicaid

answer

jointly funded, federal state health insurance for certain low-income and needy people

question

Medicare

answer

a government plan that serves people age 65 and over and disable people with chronic renal disorders

question

health maintenance organizations (HMOs)

answer

a patient who uses a health maintenance organization (HMO) pays a fixed yearly fee and must choose among an approved network of health care providers and hospitals

question

TRICARE

answer

the U.S. health program for armed service members and their families

question

CHAMPUS

answer

covers medical necessities for those eligible; retired military, dependents of those on active duty, retired, or dead military

question

CHAMPVA

answer

covers the immediate families of veterans who are totally disabled; surviving spouse and children of a veteran who died from a service related disability; widow and children of a veteran who was permanently disabled; and the surviving spouse and children of a member of the military who died in the line of duty

question

capitated plan

answer

a physician is paid a fixed fee (the capitation), and the physician is paid regardless of the amount of the treatment he or she provides

question

health insurance exchanges (HIEs)

answer

marketplaces that allow individuals and small business owners to pool their purchasing power to negotiate lower rates

question

claim

answer

a request to an insurance company for payment for services

question

CMS-1500

answer

the most widely accepted claim from (formerly called HCFA-1500)

question

UB-04

answer

it is a claim form

question

electronic media claim (EMC)

answer

is an electronically processed and transmitted claim

question

clearinghouse

answer

practices that submit electronic claims use a clearinghouse - a business that collects insurance claims from providers and sends them to the correct insurance carrier

question

explanation of benefits (EOB)

answer

the response of an insurance company to a paper claim includes an explanation of benefits (EOB), which explains why certain services were covered and others not

question

electronic remittance advice (ERA)

answer

accompanies the response to an electronic claim to an insurance company

question

bucker billing or balance billing

answer

bucket billing (or balance billing) is specific to health care office environments, where each insurer must be billed and payment received before the patient is billed

question

accounts receivable (A/R)

answer

include any invoice or any payment from the patient or insurance carriers to the medical practice

question

Patient Protection and Affordable Care Act (2010)

answer

expands health insurance coverage to 32 million more people by requiring them to buy health insurance. It also expands Medicaid coverage and reforms current insurance practices. U.S. citizens and legal residents would be required to buy "minimal essential coverage"

question

patient day sheet

answer

lists the days patients, chart numbers, and transactions

question

procedure day sheet

answer

a grouped report organized by procedure

question

payment day sheet

answer

a grouped report organized by providers

question

practice analysis report

answer

generated on a monthly basis; a summary total of all procedure, charges, and transactions

question

patient aging report

answer

used to show a patient's outstanding payments

question

The _____ is a code used by private and government insurers to determine insurance reimbursement.

answer

DRG

question

Managed care plans and ____ may require that the provider get authorization before a procedure is performed.

answer

PPOs (Preferred Provider Organizations)

question

Centers for Medicare and Medicaid Services (CMS) administers ____.

answer

Medicare and Medicaid

question

_____ provides 250,000 codes for such things as symptoms, history, physical exams, tests, diagnoses, and treatment.

answer

MEDCIN

question

_____ applications include the use of computers in office management, accounting, scheduling, and planning.

answer

Administrative

question

Medicare serves ____.

answer

People over the age of 65 and people with chronic renal disease

question

A ____ is used to show a patient's outstanding payments.

answer

patient aging report

question

A ____ is generated on a monthly basis and is a summary total of all procedures, charges and transactions.

answer

practice analysis report

question

A ____ lists the day's patients, chart numbers, and transactions. It is used for daily reconciliation.

answer

patient day sheet

question

A ____ is a grouped report organized by procedure.

answer

procedure day sheet

question

A ____ is a grouped report organized by providers.

answer

payment day sheet

question

Practices that submit electronic claims use a/an ____, a business that collects insurance claims from providers and sends them to the correct insurance carrier.

answer

clearinghouse

question

The insurance company's response to a paper claim includes a/an ____, which explains why certain services were covered and others were not.

answer

EOB (explanation of benefits)

question

____ are marketplaces "that allow individuals and small-business owners to pool their purchasing power to negotiate lower rates."

answer

HIEs (Health Insurance Exchanges)

question

The insurance company's response to an electronic claim includes a/an ____, which explains why certain services were covered and others were not.

answer

ERA (electronic remittance advice)

question

A superbill or encounter form is a list of diagnoses and procedures common to the practice.

answer

True

question

A patient is not responsible for the co-payment.

answer

False

question

Charges, payments and adjustments are called transactions.

answer

True

question

Under fee for service insurance plans, the patient is required to pay a deductible before the insurance company will cover medical costs.

answer

True

question

A patient who uses a health maintenance organization (HMO) pays a fixed yearly fee and can choose among any health care provider or hospital.

answer

False

question

ICD-9-CM and ICD-10-CM provide codes for more than 1,000 diseases.

answer

True

question

Today, hospital reimbursement by private and government insurers is determined by diagnosis. (DRG).

answer

True

question

Bucket billing is used by medical offices to accommodate two or three insurers, who must be billed in a timely fashion before the patient is billed.

answer

True

question

Doctors who accept assignment require payment by the patient, not the insurance company.

answer

False

question

Medicaid finances health care for millions of low-income people, with money provided by the federal government and the states.

answer

True

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