Administrative assisting module

Question 1

appointment book

Answer 1

• a book used to schedule, cancel, and reschedule appointments
• can be color-coded or arranged so a week is shown at a glance

Question 2

matrix

Answer 2

• a table used for scheduling

Question 3

template

Answer 3

• an outline used to make new pages with a similar design, pattern, or style

Question 4

no-show

Answer 4

• appointment that an individual fails to keep without giving notice

Question 5

referral

Answer 5

• directing a patient to a specialist

Question 6

wave scheduling

Answer 6

• scheduling three patients at the same time to be seen in the order in which they arrive

Question 7

modified wave scheduling

Answer 7

• scheduling two patients to arrive at a specified time and the third to arrive approximately 30 minutes later, repeated throughout the day

Question 8

double-booking

Answer 8

• scheduling two patients at the same time with the same provider, often to fit in a patient who has an acute illness

Question 9

notice of privacy practices

Answer 9

• a notification by providers required by the HIPAA Privacy Rule that provides an understandable explanation of patients’ rights with respect to their personal health information and the privacy practices of their providers

Question 10

screening

Answer 10

• examining and separating into groups

Question 11

automated call routing

Answer 11

• a software system that answers phones automatically and routes calls to staff after the caller responds to prompts; also used to call patients to remind them of upcoming appointments

Question 12

copay

Answer 12

• a specified sum of money based on the patient’s insurance policy benefits due at time of service

Question 13

coinsurance

Answer 13

• an amount a policyholder is financially responsible for according to their insurance policies provisions
• typically in ratios (80/20)
• must meet deductible amount before the medical insurance company will contribute their portion

Question 14

deductibles

Answer 14

• a specified sum of money a patient must pay out of pocket before the insurance carrier begins paying for services
• usually on a calendar year accrual basis

Question 15

explanation of benefits

Answer 15

• provided to patient by insurance company as a statement
• details what services were paid, denied, or reduced in payment
• also includes information pertaining to amounts applied to the deductible, coinsurance, or allowed amounts

Question 16

remittance advice

Answer 16

• an explanation of benefits sent to the provider from the insurance carrier
• contains multiple patients and providers
• also included is the electronic fund transfer information or a check for payment
• used to post payments to patient accounts

Question 17

advanced beneficiary notice

Answer 17

• a form a Medicare patient will sign when the provider thinks Medicare might not pay for a specific service or item
• patient has the option to choose to have Medicare billed, so an officially payment decision is made and a Medicare Summary Notice is sent to the patient with an explanation for noncoverage, or to not have the charges submitted to Medicare, and receive the services from the provider with the understanding that the patient is responsible for payment at the time of service without the ability of appealing to Medicare or deciding not to receive the services
• needs to be signed by the patient before services are provided, with a copy kept on file and a copy to be given to the patient

Question 18

federal policies

Answer 18

• includes Tricare (covers military personnel and their dependents)
• Medicaid is funded by the federal government and managed by the state; it covers those who meet specific eligibility criteria set by the state
• Medicare is a federal program that covers individuals age 65 and older who need coverage due to specific medical issues
• Workers’ compensation is a state legislative law that protects employees against the cost of medical care resulting from a work-related injury

Question 19

private policies

Answer 19

• group policies offered through an individual’s employer who will usually pay a portion of the premium and deduct the remainder of the premium from the employee’s paycheck
• individual policies are insurance plans that an individual funds themselves
• patients might may the entire premium themselves if they are self-employed

Question 20

ICD-10-CM coding

Answer 20

• contains approx. 55,000 more codes than ICD-9-CM
• allows for more specific reporting of diseases and newly recognized conditions
• three to seven characters
• first character is alphabetical, second and third characters are numeric, and fourth, fifth, sixth, and seventh characters are alphabetic or numeric

Question 21

ICD-10-PCS

Answer 21

• ICD-10-Procedure Coding System
• comprised of medical classifications for procedural codes typically used within hospitals that record various health treatments and testing
• a replacement for ICD-9-CM, Volume 3

Question 22

CPT codes and modifiers

Answer 22

• Current Procedural Terminology codes
• five digit numeric codes used to describe an evaluation/management service rendered by providers
• all information in the medical record must be accurate for the correct code to be documented

Question 23

HCPCS

Answer 23

• Healthcare Common Procedure Coding System
• codes created by the Centers for Medicare and Medicaid Services to report supplies, materials, and other procedures and services not defined in the CPT manual

Question 24

account balance

Answer 24

• the amount owed on an account

Question 25

debit

Answer 25

- an amount owed

Question 26

credit

Answer 26

- the monetary balance in an individual's favor

Question 27

accounts receivable

Answer 27

- money owed to the provider

Question 28

accounts payable

Answer 28

- debts incurred, not yet paid

Question 29

assets

Answer 29

- the entire saleable property of a person, association, corporation, or estate applicable or subject to the payment of debts

Question 30

liabilities

Answer 30

- amounts owed; debts

Question 31

electronic medical record

Answer 31

- an electronic record of health-related information about an individuals that can be created, managed, and accessed by authorized individuals within a single health care organization

Question 32

electronic health record

Answer 32

- an electronic record of patients' health-related information that conforms to nationally recognized interoperability standards, and can be created, managed, and accessed by authorized individuals from multiple health care organizations

Question 33

occupational safety and health administration

Answer 33

- OSHA - responsibilities are to reduce workplace injuries, illnesses, and fatalities - requires all facilities with more than 10 employees to have a written emergency evacuation plan, exit routes, protocols for employees who operate equipment, a method to account for all employees after evacuation, name of the individual responsible for the plan, and a list of personal protective equipment to be used to prevent exposure to bloodborne pathogens

Question 34

safety data sheets

Answer 34

- detail vital information about any product or chemical used in the medical facility - clarifies the correct use of the product and the proper action if a spill occurs