![]() |
Creado por MARIA DE LAS NIEVES
hace más de 9 años
|
|
What should be your priority as a billing specialist?
What is the primary goal of a medical insurance billing specialist?
What is revenue?
What is cycle?
Two billing components exist:
What is facility billing?
What is professional billing?
What a non-physician practitioner (NNP) means?
A synonym for Non-physician practitioner(NNP)
Who can be a NNP
Payment schedules for payment of professional services are based on
Under Medicare, physicians are paid according to relative value units, which are based on
Several job title names are associated with medical billing personnel. The professional title used depend on
Some of the most popular titles include insurance billing specialist are
Cost pressures on health care providers are forcing employers to be more efficient, and hiring
What do claims assistance professionals (CAPs) do?
Administrative front office duties have gained in importance for the following reasons
Diagnostic and procedural coding must be
Cash flow is
An insurance billing specialist in a large medical practice may act as
The insurance billing specialist discusses
Insurance billing speciaist knowledge, skills and abilities
insurance billing specialist knowledge, sikill and abilities
Insurance Biling Specialist (IBS)knowledge, skills and abilities
IBS knowledge skills and abilities
IBS knowledge, skills and abilities
IBS responsabilities
IBS responsabilities
IBS responsabilities
The American Association of Medical Assistants (AAMA) developed a role delineation study in
What do the insurance billing or coding specialist accredited program offers as an additional education
For a job as a coder is necessary
A codificador medical assistance insurance billing
AHIMA
AHIMA has published diagnostic and procedure coding competencies for
IBS can receive a salary depending on
Self-Employment or Independent contracting demands
Medical etiquette has to do with
Customs, courtesy, and manners of the medical profession cam be expressed in 3 words
Principles of ethics for the insurance billing specialist:
Principles of ethics for the insurance billing specialist:
If you discover that a patient in your practice may have questionable issues of care
Never keep another physician who wants to talk about a medical case to your physician employer waiting longer than necessary in the reception room
Always connect another physician who is calling on the phone to your physician immediately asking a few questions as possible.
Follow the basic rules of etiquette with co-workers while working in the office.
Identify yourself to callers and people you call
Maintain a professional demeanor and a certain amount of formality when interacting with other.
Observe rules of etiquete when sending e-mail messages an placing or receiving cell phone calls.
Medical ethics
The earliest written code of ethical principles and conduct for the medical profession was originates in
In 1980, the American Medical Association (AMA)
Violating guidelines by using code numbers or modifiers to increase payment when the case documentation does not warrant it
Coding services or procudures that were not performed for payment.
Unbundiling services provided into separate codes when one code is available and includes all the services
Failing to code a relevant condition or complication when it is documented in the health record, or viceversa, assigning a code without documentation from the provider.
Coding a service in such a way that it is paid when usually it is not covered
Coding another condition as the principal or primary diagnosis when most of the patient's treatment is for the preexisting condition.
Physicians are legally responsible for their own conduct and any actions of their emplyees performed within the context fo their employment.
An insurance biller always should check with his or her physician-employer to determine whether he or she is included in the medical professional liability insurance policy otherwise
Future goals for a insurance IBS
goals for an IBS
If IBS change the date of service for get into insurance policy to bill charge
Hay una exclusion para el derecho de privacidad
Best practice when you call a patient
Who handles the code of ethics for IBS?
AAMA
ACA
AHIMA
AMA
ASHD
CAP
GED
HIPAA
listserv
MSHP
MSO
NPP
ARRA
CERT
CLIA
CMP
CMS
DHHS
DOJ
FBI
FCA
FDIC
FTP
HCFAP
HEAT
HIPAA
HITECH
IIHI
MIP
npp
OCR
OIG
ORT
OSHA
P&P
PHI
PO
RAC
SDP
TPO
ZPIC
COMPLIANCE in the health care industry
Title of HIPAA (Health Insurance Portability and Accountability Act) focuses on the health care practice setting and aim to reduce administrative costs and burdens
The HIPAA Title that provede continuous insurance coverage for workers and their insured dependents when they change or lose jobs.
What is a clearinghoue?
What a covered entity may be?
Who is a business associate?
A health care provider is
Is designated to help the provider remain in compliance by setting policies and procudures (P&P) and by training and managing the staff regarding HIPAA
OCR (Official of Civil Rights)
Confidentiality
PHI (Protected health information)
Under the HIPAA (Health Information Portability and Accountability Act) what is authorization
Authorizatin form is necessary for
Confidentiality between the physician and patient is automatically waived in the following situations:
Confidentiality is waived in the following situations:
Confidentially physician and patiente is waived in
Confidiantelly between physician patients waived if
Confidential Communicatios is
Everything you see, hear, or read about patients remains
Privileged information is related to
Nonprivileged information
What do yo have to do if a relative telephones asking about a patient?
Unathorized release of information is called
Telephone conversations by provides in front of patients
The Security Rule comrises regulations related to the
The Health Information Technology for Economic and Clinical Health Act (HITECH) was a provision of
HITECH brought significant compliance changes to three very especific areas
HIPAA established
What AAMA (American Association of Medical Assitance) handle?
Do's of Confidentiality
Don't of Confidentiaity:
The HITECH defines a breach as the
Claim submission is the responsibility fo
Medical Ethics include
Report incorrect information to third-party
If physician charge for innecesary visits is
Report false information is
The OCR (Office of Civil Rights), oversees
The OIG (Office of Inspector General) provides
The mission of OIG (Office of Inspector General) is
The OIG (Office of Inspector General) was established to
Billing for services or supplies not provided (phantom billing or invoice ghosting)
Bill for an office visit if a patient fails to keep an appointment and is not notified ahead of time that this is office policy
Alter fees on a claim for to obtain higher payment
Forgive the deductible or copayment
Alter medical records to generate fraudulent payments
Leave relevant information off a claim, as failing to reveal whether a spouse has health insurance coverage through an employer
Upcode. Submitte a code for a complex fracture when the patient had a simple fracture.
Shorte. Dispensing less medication than billed for
Split billing schemes. Billing procedures over a period of days when all treatment occurred during one visit
Use another person's insurance card in obtaining medical care
Change a date of Service
Post adjustments to generate fraudulent payments
Solicit, offer or receive a kickback, bribe or rebate in return for refering a patient to a physician or NPP
Referring a patient to obtain any item or service that may be paid for in full or in part by Medicare or Madicaid
Restate the diagnosis to obtain insurance benefits or better payment
Apply deliberately for duplicate payment. Billing Medicare twice, billing Medicare and the beneficiary for the same service or billing Medicare and another insurer in an attmpt to get paid twice
Unbundle or explode charge. Billing a multichannel laboratory test as if individual tests were performed
Collusion between a physician and an employee of a third-party payer when the claim is assigned
Physician deliberately overbilled for services, overpayments could be generated with little awareness on the part of the Medicare beneficiary
Refer excessively to other providers for unnecessary services
Charge excessively for services or supplies
Perform a baterry of diagnostic test when only a few are required for services
Violate Medicare's physician participating agreement
Call patients for repeatd and unnecessary follow-up visits
Bill Medicare beneficiaries at a higher rate than other patients
Submit bills to Medicare instead of to third-parthy payers, like claims for injury from an automobile accident, in store, or the workplace.
Breach assignment agreement
Fail to make required refunds when services are not reasonable and necessary
Require patients to contract to pay their physician's full charges, in excess of the Medicare charge limits
Require a patient to waive rights to have the physician submit claims to Medicare and obligate a patient to pay privately for medicare-covered services
Require a patients to pay for services not previously billed, including telephone calls with the physician, prescription refills, and medical conferences with other professionals
Require patients to sign a global waiver agreeing to pay privately for all services that Medicare will not cover, and using these waivers to obligate patients to pay separately for a service that Medicare covers a part of a package or related procedures
Published the Compliance Program for Individual and Small Group Physician Practices in September, 2000
The Compliance Program for Individual and Small Group Physician Practices was provided as
A well-designed compliance program can
Is the key individual overseeing your organization's compliance program monitoring with the support of the Compliance Committe
"Open door" policies ensure
The insurance industry is
Contract
The physician-patient contract begins when
Implied contract
An expressed contract
For a patient who carries private medical insurance, the contract FOR TREATMENT is
PPO
The patients who belong to a PPO (preferred provider organization)
Guarantor
An emancipated minor is
Workers' Compensation (WC) cases
Major medical or extended benefits contracts are
The insured is known as a
Eligibility verification means
In private health insurance, there are five classifications:
Canceleable policy
Optionally renewable policy,
Conditionally renewable polices
Noncancelable policy
coinsurance or cost-sharing requirement means
copayment (copay)
COB
A COB is
Birthday law
In the birthday law, if mother and father have the same birthday, who is the primary
In cases of divorce, consider that you are not an enforcer of court laws
Health insurance policies contain exclusions
Preexisting conditions
Precertification refers
Preauthorization relates
Predetermination means
Blanket contract
What is conversion privilege
Usually conversion from a group adventage
Veterans' Health Administration (CHAMPVA) "Civilian Health and Medical Program of the Department of Veterans Affairs.
If the person has a condition that would make him or her ineligible for coverage is a case considered