Week 2 Flashcards
0
Q
How do documents arrive in onbase? (3 ways)
A
Electronic, fax, hardcopy
1
Q
Onbase
A
Document storage and retrieval
2
Q
ObServer
A
Used by quadax and clients that dont pay for their own database
3
Q
3 ways to search for a document in onbase
A
Group, type, keyword
4
Q
Indexing
A
Assigning keywords to document
5
Q
Wildcards (2 types)
A
- multiple characters
? One character
6
Q
How to display multiple search fields in onbase
A
F6 or double click
7
Q
shortcut key in onbase
A
Alt
8
Q
Which page in harp and pas do you access onbase from?
A
Related tasks & journal
9
Q
Remittance
A
Result of payer claim processing
10
Q
Allowed amount
A
Payer fee schedule
11
Q
Filing limit
A
Maximum time from service to filing
12
Q
5010
A
Claim transaction standards to go along with hipaa
13
Q
Requisition
A
How lab orders and tracks a test
14
Q
Accession
A
How lab tracks individual tests
15
Q
Front end order entry system
A
Software that orders tests and receives results electronically
16
Q
Ncd/lcd edits
A
National/local coverage determinations; medicare requires specific icd9 codes
17
Q
Independent reference lab
A
Unique tax id & address
Direct contract
Cms1500
18
Q
Hospital outreach lab
A
Hospital id and address
Hospital contract
Ub04
19
Q
Lab network
A
Multiple members with own ids and addresses
Networked to get insurance contracts
20
Q
Pathology lab
A
Unique tax id and pay to address
Cms1500
21
Q
Esoteric/genetic lab
A
Venture capital funded
Highly specialized tests
22
Q
New client implementation (5 steps)
A
12 week implementation Weekly conference Interface dev Harp database dev Policies and procedures
23
Q
Fee for service billing
A
Goes directly to payer
24
Roster billing
Goes to client, contract between lab and provider, billed on invoice monthly
25
6 benefits of quadax billing
```
Carves out a/r
Efficient for low volume
Low charge
Expertise with labs
Tech/service org
Reporting options
```
26
Human genome project
Total genetic info in human chromosomes, 20k genes, sequencing took 6-8 years and $1 billion
27
4 Benefits of human genome mapping
Improved genetic testing, birth defect id, customized therapy, dna repair
28
Genetics
Study of inheritance
29
Dna
Inherited from parents, genetic info for all living cells
30
Gene
Unit of heredity passed through chromosomes to offspring
31
Genetic mutation
Permanent change in dna sequence - inherited or acquired
32
Polyploidy
Extra copy of every chromosome
33
Trisonomy
Three copies of a chromosome
34
Monosomy
Entire chromosome missing
35
Autosomal recessive gene
2 copies needed (one from each parent)
36
Autosomal dominant gene
1 copy from 1 parent needed
37
Genomics
Study of all genes and interactions
38
Genomic testing
How genes affect development of a condition
39
Cancer definition
Disease caused by uncontrollable division of abnormal cells, always named for place of origin
40
Metastasis
Spreading
41
Micrometastasis
Spread of cells too small to be detected
42
Sentinel lymph node
First nodes that cancer filters through, biopsy can be used to determine metastasis status
43
Cancer stages
Used to describe extent (size of tumor, metastasis level)
44
Lymphoma
Cancer of lymph nodes
45
Sarcoma
Cancer of connective tissues
46
Leukemia
Cancer of blood
47
Carcinoma
Cancer of skin or tissue covering organs
48
Orphan cancer
Affects small portion of population
49
Tumor markers (5)
```
Her2 - breast or ovarian
Estrogen
Progesterone
Psa - prostate
Egfr - lung
```
50
Standard of care
Treatment based on best practices (works for majority of patients)
51
Neoadjuvant
Before primary treatment
52
Adjuvant
After primary treatment
53
Chemotherapy
Toxic drugs, systemic
54
Radiation
Systemic, x-rays
55
Targeted therapy
Toxic drugs locally
56
Immunotherapy
Use of immune system, aka biotherapy
57
Hormone therapy
Drugs to suppress hormone production (reproductive cancers)
58
6 results of ineffective treatment
Tumor progression, accumulated toxicity, side effects, cross resistance, decreased effectiveness, lower quality of life
59
5 features of pas
Hijar - highly customizeable, integration with harp, journal, automated workflow, robust reporting system
60
6 components of pas
Abcpop - appeal, benefit investigation, claim processing, prior auth, ordering physician, patient responsibility
61
Define workflow
Reimbursement steps broken down to event/tasks on work lists
62
Sop
Standard operating procedures, given by client as instructions to work a list
63
4 pages of pas
Patient lookup, journal, view/update patient, view/update insurance
64
3 parts of journal
Case info, insurance info, journal
65
Work list status
Yellow - priority, white - open, gray - wait, red - hold
| Grayed out - wait, bold - priority
66
Entity comments
Indicated with orange text
67
Red on insurance plan
Preclaim requirement exists
68
red on status date
Someone else is working the case
69
Event task relationship codes
W - work list created or updated
S - case status updated
W/s- both w and s
U - work list updated but not created if does not already exist
70
Color letter boxes
Quick clue as to test being performed
71
Load file
Demo and charges, as well as any other documents, are passed from client to quadax
72
Data verification
Load file cross referenced from docs sent to onbase
73
L06
Unbillable insurance, must be updated to correct insurance
74
Dvmi
Data verification missing info work list, indicates client contact required (quadax places on priority, journal note to say whats needed, client responds and puts back to open status)
75
Benefit investigation
3 steps - pending bi, patient notification of bi, md notification of bi
76
Pending bi
Outsourced call to insurance is first step of bi
77
Patient notification of bi
Quadax calls patient to review finances and assistance
78
Md notification of bi
Call or fax to doctor to tell results of bi
79
4 bi options
No bi
Do bi, proceed immediately with test
Do bi, hold for approval
Hold pending patient out of pocket expense (prostate only)
80
Electronic eligibility
Elel, ansi 270
Sent to payer to confirm eligibility
Worked automatically by xpeditor
81
Review response
Rere, ansi 271
Response from insurance after elel, posted automatically to journal
Completes automatically unless trigger requires intervention
82
Manual verification of insurance
Performed after test is done for clients that dont use bi
83
4 pre-claim requirements
Prior auth, somn, medical records, pcp referral
84
Prior authorization
Approval prior to test, does not guarantee payment
85
Somn
Statement of medical necessity, checkbox form filled out by physician
86
Medical records
Documentation of medical history that indicates medical necessity
87
Pcp referral
Referring physician, used for hmo plans
