Practice Management & EHR, chapter 9 – Flashcards
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modifier
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A number appended to a code to report particular facts
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adjustments
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Changes to a patient's account
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unbundling
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The incorrect billing practice of breaking a panel or package of serves/procedures into component.
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code linkage
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The clinically appropriate connection between a provided service and a patient's condition or illness.
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charge capture
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The process of recording billable services
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compliant billing
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Billing actions that satisfy official requirements
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query
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A request for more information from a provider
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CCI modifier indicators
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The numbers showing if the use of a modifier can bypass a CCI
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global period
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The days surrounding a surgical procedure when all services relating to the procedure are considered part of the surgical package.
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bundled code
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Two or more related procedure codes combined into one
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T/F In Medisoft, the Unprocessed Charges window displays transactions transmitted from the EHR program that have already been posted in Medisoft.
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F
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T/F Patients who do not have insurance coverage are called self-pay patients.
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T
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T/F A modifier usually affects the normal level of reimbursement for the code to which it is attached.
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T
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T/F In Medisoft Clinical Records, some patient education hand-outs are available in English and in Spanish.
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T
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T/F Payments are entered in two different areas of the Medisoft program: the Transaction Entry dialog box, and the Deposit List dialog box.
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T
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T/F The amount of copayment that is due depends on whether the provider is in the patient's network and on the type of service.
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T
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T/F Noncompliant billing refers to flowing these rules os that the practice and the health plan have the same expectations for the payment that will be made.
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F
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T/F CCI edits apply to claims that bill for more than one procedure performed on the same patient, on the same date of service, by the same performing provider.
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T
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T/F Walkouts receipts include only information on the procedures and diagnosis for patient visit
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F
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T/F PM/EHRs typically have a capability called claim scrubbing.
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T
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________ are changes to patient's accounts.
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Adjustments
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_________ are the amounts a provider bills for the services performed.
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Charges
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___________ are monies received from patients and insurance carriers.
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Payments
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_________ describes the connection between a procedure code and the related diagnosis code(s).
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Code linkage
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__________ is the incorrect billing practice of breaking a panel or package of services/procedures into component parts.
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Unbundling
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________ refers to following billing rules so that the practice and the health plan have the same expectations for the payment that will be made.
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Complaint billing
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_________ is the process of recording billable services.
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Charge capture
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________ are groups of procedure code entries that relate to a single activity.
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MultiLink codes
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A _________ is a group of related procedures and/or services included under a single code.
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package
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A __________ is a number appended to a code to report particular facts.
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modifier
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RTCA
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real-time claim adjudication
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MUE
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medically unlikely edit
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MEC
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mutually exclusive code
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CCI
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correct coding initiative
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POS
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place of service
