MHU1TS: Health Care Flashcards
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When do patient encounters begin in the clinic?
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Patient telephones clinic for appointment.
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In the next 30-50 years what will happen to the population of people over the age of 65?
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It will double.
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What do patients consider surrogates?
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Office location, size and layout.
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How much personal information should physicians give to their patients and why is it important that they are \"relate-able\" to their patients?
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Only enough information for their patients to relate to them.
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Can a third party receive patients' confidential information? What is the process?
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Yes, with written permission.
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What does \"assignment of benefits\" mean?
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Arrangement of payments to be made directly to provider.
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What is a daily journal and what does it contain?
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Chronological record of all patient transactions including previous balances, changes, payments, current balances.
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What kind of information is needed for a patient information form?
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Name, address, employer, health insurance.
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What are the time limits for submitting claims?
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One year.
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What information is needed to request an appeal?
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Beneficiary's name, medicare health insurance claim number.
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What are the five categories of problem debtors?
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Something else came up; Chronically slow; Can't pay; Forgetful; Fraudulent.
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Before a small claims can proceed the court expects____________ to explore all options of settlement.
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The Plaintiff.
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What is a defendant?
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The party being sued.
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Who does Fair Debt Collection Practices Act Address?
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Bill collectors hired to collect overdue bills.
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What information is on an insurance card?
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Member name; Group number.
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What was the reason for revising CMS-1500?
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HIPAA mandated NPI.
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Explanation of benefits is also referred to as:
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Explains the outcome of the claim submitted.
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When a COB exists what do you need to do?
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Verify which payer is primary and which is secondary.
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What is the One-Write or Pegboard system?
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Useful method of accounting for small practices.
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What is a billing cycle?
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Routine for sending statements, which are mailed periodically, usually every 30 days.
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Truth in Lending Act allows up to how many installments in a payment plan?
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4.
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What is a collection agency?
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An organization that obtains or arranges for payment of money owed to a third party.
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What is an EIN number and how many digits is it?
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Employer Identification Number; Nine digits.
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What are the OCR guidelines/directions for completing forms?
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Use all uppercase letters, Omit all punctuation, Use the MM/DD/YYYY format, Use a space instead of usual punctuation.
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Where is the patients' information entered at?
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Top of the form.
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What is the name of the organization that revised the CMS-1500 form?
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National Uniform Claim Committee.
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What kind of services need pre authorization or precertification?
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Inpatient hospitalizations, new or experimental procedures, certain diagnostic studies.
