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45 Cards in this Set
- Front
- Back
Clerk who enters patients demographical information into a computer nd obtains signed statements from patients to protect hospitals interests
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Admitting Clerk
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Specializes in maintaining patient accounting records, filing health insurance claims, working insurance carriers to receive imbursement on insurance claims filed, appealing denied claims
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Centralized Billing Office
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Training received in a particular field that acknowledges a medical office specialists expertise
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Certification
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A facility that centralizes the process of billing patients and carriers for treatment received at an inpatient facility
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Patient Account Services
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Coordinates services related to inpatient medical coding, documentation, abstracting data collection and reimbursement
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Registered Health Information Technician
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a business that contracts with physicians to handle their claims and/or accounts receivable is referred to as a
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Physicians billing office
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What job description requires excellent data entry skills, math skills, and a good working knowledge of insurance contracts
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Payment poster
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a meical collector will contact most patients by
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telephone
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a refund specialist position requires
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researching and analytical skills
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What abbreviation stands for a coder who specializes in hospital coding?
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CPC-H
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A large Physician group practice consists of
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10 plus physicians and physcians who practice in different specialities
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a small physician group practice consists of
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three through nine physicians ; physicians usually practicing the same specialty
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Which law establishes guidelines to ensure patient privacy compliance and healh plan portability
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HIPPA
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A person who is covered under and insurance policy is known as the
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policyholder
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_______ and ______ are other job titles for a medical biller
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Billing specialist Patient Account Representative
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a medical office assistant may be also referred to as a medical
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receptionist or secretary
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Professional membership is an excellent addition to your
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resume
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The payment Poster generally reads the ____ from insurance carriers and posts the payments or contractual adjustments to the appropriate patient account
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EOB
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The knowledge of medical ___ and ___ is imperative to perform well in all medical administrative positions
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Billing Coding
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The Amount employees had to pay out of their pockets before insurance began paying is called the _______
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Deductible
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A physicia who coordinaes a patient's care and refers patients specialists is a
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Primary Care Physcian
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A ____ contracts with more than one community based multispecialty group to provide wider geographical coverage
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HMO
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When a provider agrees to receive payment directly from the patients insurance carrier it is accepting
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Assignment of Benefits
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A _____ medical condition is a diagnosis that the insured has previously been treated fo and that may not be covered by a traditional insurance plan
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Preexisting
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The lists of medical services covered uder the insured policy is called the
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Schedule of benefits
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The charge a covered person is required to pay at the time covered services are provided is a
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copay
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A managed care contract is a legal between a healthcare ___ and a _____
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HMO, NEtWoRK
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When an MCO examines a physicians background for evidence of fraud or criminal activity the process is called
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Credentaling
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Managed care is a system that controls the ___ and the ___ of health services to members
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Cost, Delivery
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The Goals of managed Care includes all of the following except
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Medical Care that is rendered in the least restrictive setting
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Managed care systems ensure the delivery of high-quality Care while managing costs through
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networks of providers, Discounted Fees
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Terms used to refer to fees in an insurance contract include all of the following except
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ordinary
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to determine the amount due from a patient it is necessary to know the
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allowed amount
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which of the following plan types does not use a network of providers
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indemnity plan
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in a managed care organization, a primary care physician is typically any of ht following except
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dermatologist
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The Duties of a primary care physician in a health maintenance organiztion include
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all of the above
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types of managed care plans are
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HMO, PPO, POS
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The fixed dollar amount a member pays at each office visit or hospital encounter is called
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copayment
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Primary care physicians in a health maintenced organizations can include
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family practice, general practice, internal medicine and OB/Gyn
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In managed care contracts Pmpm refers to
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per member per month
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A feature of a preferred provider organization includes which of the following
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Both a nd B
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a point of service plan allows members to
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both a nd b
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incentives for PPO members to use network providers include
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Lower out of pocket costs
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which of the following is true of self insured plans
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all of the above
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The type of insurance coverage that provides protection against a certain type of accident or illness
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special risk
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