Module 11- Administrative Testing

Question 1

What is a revenue cycle?

Answer 1

a series of administrative functions required to collect payment for services provided by the HCO.

Question 2

What is a referral?

Answer 2

is an order from a provider to see a specialist to get specific medical services.

Question 3

What is a practice management system (PMS)?

Answer 3

the administrative side of the EHR. Allows for scheduling appointments and tracking patient demographics, performing billing procedures, submitting insurance claims, and processing payments.

Question 4

What is the difference between an EMR and an EHR?

Answer 4

EMR is an electronic medial recored containg health and medical care info within a specific HCO. The biggest difference is that EHRs are maintained by multiple providers, while EMRs are only maintained by a single provider. This means that an EHR contains more information than an EMR.

Question 5

what is Real-Time Adjudication?

Answer 5

is the ability of the HCP to share documents and make decisions while a patient is present.

Question 6

What are Medicare/ Medicaid services and what is the difference?

Answer 6

Medicare is federal health insurance for anyone age 65 and older, and some people under 65 with certain disabilities or conditions. Medicaid is a joint federal and state program that gives health coverage to some people with limited income and resources.

Question 7

What is a schedule Matrix?

Answer 7

the designed time frame for appointments is based on the method of appointment durations

Question 8

Explain the different types of scheduling: ( based on time)
1. Specific Time:
2. Wave Scheduling:
3. Double-booking:
4. Clustering:

Answer 8

1- when a patient is given an individual time for their appointment.
2- scheduling multiple patients in the same time period, and patients are seen based on who arrives first. (Allows for more flexibility).
3- A system in which 2 or more patients are scheduled within the same time period.
4- scheduling patients in groups with similar medical needs.

Question 9

Who is defined as a new patient:

Answer 9

first-time patients or first encounter after a 3-year absence from the organization.

Question 10

types of office visits and the associated requirements:
1. Establoished Patients-
2. Comprehensive-
3. Preventive care-
4. Urgent-
5. other entities-
6. New Patient- Above

Answer 10

1- patients who have received services from the same provider or group for three years
2- new or established patients for a specific complaint regarding injuries, or worsening chronic conditions.
3- A thorough review of body systems including preventive screenings.
4- Medically necessary within 24 hours.
5- Non- patient related. For example, meetings, training, etc.

Question 11

Duration of each type of visit:
1. New patient-
2. Established patient-
3. Comprehensive-
4. Preventive care-
5. Urgent-
6. Other entities-

Answer 11

1- 60 min
2- 15 min
3- 45-60 min
4- 45-60 min
5- 20 min
6- 30 min

Question 12

What is an after vist summary (AVS)?

Answer 12

info that includes follow-up appointments, provider orders, instructions, educational resources, and financial account info.

Question 13

Deductible:
Coinsurance:

Answer 13

• the amount that must be paid before benefits are paid for by the insurance company.
• the % of the allowed amount the patient will pay once the deductible is met.

Question 14

What is notice of privacy practices?

Answer 14

a document that identifies how a provider will share a patient’s HI.

Question 15

What does the administrative section of a pateint’s medical record include:

Answer 15

1- patient’s demographics
2- Notice of privacy practices
3- advance directive
4- consent forms
5- Medical release forms
6- correspondence messages
7- appointments and billing information.

Question 16

What does the clinical section of the medical record include:

Answer 16

Health History
Physical examinations
Allergies
Medication record
Problem list
progress notes
Laboratory data
Diagnostic Procedures
continuity of care.

Question 17

What is an encounter form?
Encounter notes?

Answer 17

• A record of the diagnoses and procedures covered during the current visit a.k.a superbill.
• clinical notes that include history of present illness and current medications list.

Question 18

What is a patient flow sheet?

Answer 18

a sheet that records and tracks a patient’s health data

Question 19

What is a chart review?

Answer 19

performed to make sure the encounter, prescriptions, follow-ups, and communication are all accurately documented.

Question 20

1. utilization review:
2. precertfication:
3. preauthoraization:

Answer 20

1. a process used by payers to inform providers of policy payments, benefits, and authorizations.
2. a request to determine if a service is covered by a patient’s policy and what the remaining payment would be.
3. approval of insurance coverage and necessity of services prior to the patient receiving them.

Question 21

Daignostic and proecedual codes:
1. Current procedural terminology (CPT):
2. HCPCS:
3. ICD-10-CM:

Answer 21

1. states the medical services and procedures performed.
2. Supplies and services not described by CPT
3. Includes diseases, injuries, medical conditions, patient status, and other reasons for the encounter.