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An overview of various medical office scheduling and billing practices, including computer scheduling, wave booking, double booking, stream/time-specific scheduling, open booking, cluster or categorization booking, and matrix scheduling. It also covers topics related to medical administrative assistant duties, such as appointment cards, hipaa, electronic medical records, health insurance, billing and reimbursement, and medical coding systems like cpt and hcpcs. The document delves into the importance of patient demographics, consent forms, referrals, medical file management, and bookkeeping practices in a healthcare setting. It serves as a comprehensive guide for medical administrative assistants and students interested in understanding the administrative and financial aspects of medical office operations.
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Computer Scheduling ✔✔Electronic appointment book Book Scheduling ✔✔Hard copy appointment book Wave Booking ✔✔Patients are scheduled at the same time each hour to create short-term flexibility each hour. Modified Wave Booking ✔✔Wave booking can be modified in a couple of different ways. One example of this approach is to schedule two patients to come at 9 a.m. and one patient at 9: a.m. This hourly cycle is repeated throughout the day. Double Booking ✔✔Two patients are scheduled to come at the same time to see the same physician. Stream/time-Specific Scheduling ✔✔Scheduling patients for specific times at regular intervals. The amount of time allotted depends on the reason for the visit.
Open Booking (tidal wave scheduling) ✔✔Patients are not scheduled for a specific time, but told to come in at intermittent times. They are seen in the order in which the arrive. Cluster or Categorization Booking ✔✔Booking a number of patients who have specific needs together at the same time of day. Matrix ✔✔A grid with time slots blocked out when physicians are unavailable or the office is closed. Template ✔✔A document with a preset format that is used as a starting point so that it does not have e recreated each time. Screening System ✔✔Procedures to prioritize the urgency of a call to determine when the patient should be seen. Certified Mail ✔✔First-class mail that also gives the mail added protection by offering insurance, tracking, and return receipt options.
Protected Health Information (PHI) ✔✔Information about health status or health care that can be linked to a specific individual. What are three types of demographics? ✔✔Name, address, and marital status. Health Insurance ✔✔Financial support for medical needs, hospitalization, medically necessary diagnostic tests and procedures, and may kinds of preventive services. Electronic Health Record (EHR) ✔✔An electronic health record of health-related information about a patient that conforms to nationally recognized interoperability standards that can be created, managed, and reviewed by authorized providers and staff from more than one health care organization. Co payment ✔✔Fees collected from patient at the time of services. Guarantor ✔✔Person or entity responsible for the remaining payment of services after insurance has paid.
Birthday Rule ✔✔The health plan of the parent whose birthday comes first in the calendar year is designated as the primary plan. Healthcare Common Procedure Coding System (HCPCS) ✔✔A group of codes and descriptors used to represent health care procedures, supplies, products, and services. Reimbursement ✔✔Payment from insurance companies. International Classification of Diseases, ICD- 9 - CM and/or ICD- 10 - CM ✔✔Track a patient's diagnosis and clinical history. Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) ✔✔Are used to report provider services for the purpose of reimbursement. Medicare ✔✔Federally funded health insurance provided to people age 65 or older, people younger than 65 who have certain disabilities, and people of all ages with end-stage kidney disease.
DNR Form ✔✔Form that states that the patient does not want to be revived after experience a heart episode or other kind of life-threatening event. Encounter Form ✔✔A document used to collect data about elements of a patient visit that can become part of a patient record or be used for management purposes. Regular Referral ✔✔When a physician decides that a patient needs to see a specialist. Urgent Referral ✔✔When and urgent, but not life-threatening, situation occurs, requiring that the referral be taken care of quickly. STAT Referral ✔✔Needed in an emergency situation, and can be approved immediately over the telephone after the utilization review has approved the faxed document. Active Files ✔✔Section of medical charts for patients currently receiving treatment. Inactive Files ✔✔Section of medical charts for patients the provider has not seen for 6 months or longer.
Closed Files ✔✔Section of medical charts for patients who have died, moved away, or terminated their relationship with the physician. Purging ✔✔The process of moving a file from active to inactive status Provisional Diagnosis ✔✔A temporary or working diagnosis. Differential Diagnosis ✔✔The process of weighing the probability that other diseases are the cause of the problem. Direct Filing System ✔✔System in which the only information needed for filing and retrieval is a patient's name. Cross-reference ✔✔Reference to corresponding information in a separate location. Privacy Rule ✔✔A HIPAA rule that establishes protections for the privacy of individual's health information.
Accounts Receivable Ledger ✔✔Document that provides detailed information about charges, payments, and remaining amounts owed to a provider. Fee-for-service ✔✔Model in which providers set the fees for procedures and services. Allowable Amount ✔✔The limit that most insurance plans put on the amount that will be allowed for reimbursement for a service or procedure. Resource-based Relative Value Scale (RBRVS) ✔✔System that provides national uniform payments after adjustments across all practices throughout the country. Medicare Part B ✔✔Voluntary supplemental medical insurance to help pay for physicians' and other medical professionals' services, medical services, and medical-surgical supplies not covered by Medicare Part A. Petty Cash Fund ✔✔A small amount of cash available for expenses such as postage, parking fees, small contributions, emergency supplies, and miscellaneous small items. Disbursement ✔✔The record of the funds distributed to specific expense accounts.
Daily Journal ✔✔A chronological record of bills received, bills paid, and payments and reimbursements received. Day Sheet ✔✔A daily record of financial transactions and services rendered. End-of-day Summary ✔✔Document consisting of proof of posting sections, month-to-date accounts receivable proof, and year-to-date accounts receivable proof. Single-entry System ✔✔A method of bookkeeping that relies on a one-sided accounting entry to maintain financial information. General Journal ✔✔Document where transactions are entered. Double-entry bookkeeping ✔✔A system in which every entry to an account requires an opposite entry to a different account. Subsidiary Journals ✔✔A document where transactions are summarized and later recorded in a general ledger.
Insured Mail ✔✔Mail that has insurance coverage against loss or damage. Registered Mail ✔✔Mail of all classes protected by registering and requesting evidence of its delivery. Packing Slip ✔✔A list of items in a package. Terminal Numbering System ✔✔Assigning consecutive numbers to patients while separating the digits in the number into groups of twos or threes.