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Flashcards in Week 2 Deck (68):
1

If a new patient calls to schedule, what should you do?

take the time to outline policies (payment, scheduling and cancellations)
if possible, verify the insurance benefits before the aptient arrives for their first appointment

2

request for treatment

usually patient initiates by phone
ask them to arrive 15-20 minutes before the appointment

3

when the patient requests treatment, what are some things you should go over with them?

payment
scheduling
cancellations
have patient come early
online forms
welcome packet

4

welcome packet guidelines

welcome letter
patient financial respsonsibility letter
patient information form
medical and health history forms
informed consent form
HIPPA privacy policy and acknoledgements
financial hardship policy and application

5

written and printed policies available for patient guidelines

medical and health history forms (necessary)
informed consent
HIPPA privacy policy form and acknowledgements

6

what do you need to do to establish patient financial responsibility?

insurance information obtained (copy card front and back)
insurance verification (phone or internet)
financial policy explained

7

if insurance hasn't been verified, what needs to happen?

DC may have to give patient an estimate of medical fees
medicare has the ABN form

8

ABN form

advanced benefitiary notice or waiver of liability

9

what should you require from patients during the inital visit?

copy of insurance card (front and back)
verification
referrals or pre-authorization (if necessary)
have patient sign forms (request for records/release, assignment of benefits)

10

you already verified the person's insurance, do you still need a copy of their insurance card?

yes

11

what else do you need to do when you get their insurance card?

ask for a valid form of ID

12

what questions should you ask of patients who are established?

has any info changed since our last visit?
has insurance changed since last visit?
have you had any changes in your health history?

13

why do you need to ask all the questions to the established patients?

to verify if information has changed
see if their condition has changed

14

treatment plan requirements

diagnosis named
what the treatment plan will be
how many visits
how long the plan is
expected outcome and how you will measure it

15

date of onset is when for medicare?

the first date you saw the patient

16

documentation needed after appointment

document what happened
complete a fee slip (superbill)
collect any money owed from the patient
remin patient of next appointment (write down on card or have them write it down)

17

EOB/remittance

a form sent to the patient (proider) stating what has been paid by insurance and what patient owes

18

how do you get a reimbursement?

service must be
covered under payer's health benefit plan
medically necessary according to apyer
appropriately documented in patient's medical record

19

define medically necessary services

have been established as safe and effective
are consistent with symptoms or diagnosis
are necessary and consistent with generally accepted medical practices
are furnished at the most appropriate, safe and effective level

20

paradigm shift

cost sharing
patient needs to understand that most insurances will not pay 100% of the bill
patient needs to understand they need to accept responsibility for their portion of the bill

21

5 most common features of cost sharing

deductible
co-pay
co-insurance
elimination/waiting periods
out of pocket max

22

flow chart for payment

submit a claim
is claim paid (follow up in 30 days if not, if yes, match EOB)
is payment correct? (have policy in place if no)
follow up
send to collections
rejected or denied?
file and appeal
appeal again (if you can)
write off disallowed amount

23

if there is overpayment, what do you do? underpayment?

overpay- pay back ASAP
underpay- appeal

24

how often do you follow up on payments?

at least every 30 days
run reports in 30, 60. 90 day intervals
try to work out regular payments with patient before you send to collections

25

send to collections

should be outlined in payment policy and not an emotional decision
pay for a company to collect money for you (50% of what is collected)

26

disallowed amount

insurance adjusted amount or network savings
then balance bill to patient

27

essential benefits list

ambulatory patient services
emergency services
hospitalizations
maternity and newborn care
mental health and addiction treatment
prescription drugs
rehabilitative and habilitative services and devices
lab services
preventative and wellness services and chronic disease management
pediatric services, including oral and vision care

28

premium

buying insurance

29

deductible

amount that patient has to pay in a time period before benefits will be paid (typically per calendar year)

30

after deductible, who pays?

patient

31

managed care

created to contain costs and maintain quality

32

MCO

AKA HMO, PPO
(health maintenance organization or preferred provider organization)
actively manages medical aspect of patient care, financial aspect of patient care

33

MCO characteristics

selected providers furnish package of services to enrollees
explicit criteria for selection of providers
quality assurance, utilization review, outcome measures
incentives
penalties
risk-sharing
appropriate care, cost-effective mix

34

billing MCO

contact them
billing manuals and instructions
be sure to understand extra costs involved with MCO

35

1500 claim form

AMA, CMS and payer organizations created it
most insurances use this

36

where can you look for claim form?

chirocode deskbook
www.nucc.org

37

HSA acronym meaning

health savings account

38

HRA

health reimbursement arrangement

39

MSA

medicare medical savings acount

40

VEBA

voluntary empolyee benefit association

41

MEWA

multiple employer welfare arranement

42

HSA job

permits eligible individuals to save and pay for health care expenses on a tax free basis
empowers patients to spend their own money
money is held in a tax exempt trust or custodial account
to qualify, patient must have a high deducible health plan

43

MSA job

for medicatre patients
enrollment annual
eliminates need for medigap
patient can pay for services not covered by medicare
patient can "save up" for future expenses

44

HRA job

employer sponsored
patient can determine how, when and where the money is spent
may promote better doctor patient relationships

45

VEBA job

empolyees ina geographic area band together
create member owned healthcare plans
growth and impact has been small but is growing

46

MEWA job

two or more unrelated employers may establish a healthcare plan
can use insurance or another type of funding
designed to give small employers access to low cost health coverage

47

positives for cash practice

hassle free
eliminayion of administrative waste
less paperwork and overhead cost
no insurance forms/bills
no referral approval/authorization
lower fees to patients

48

risks for cash practice

fewer patients initially
having false illusions that quality is not important
may become a target of unfair fee allegations by 3rd party payers

49

personal injury examples

MVA
accidents in a home where patient doesn't reside
accidents occuring on a business site not work related

50

sources of payment for bodily injury

fault-based
no-fault
attorney
health insurance/HMO/PPO
patient payment

51

faulty based

liability
under/uninsured motorist

52

no fault

medpay
personal injury protection

53

attorney

will disburse payments from case

54

health insurance/HMO/PPO is used if..

fault-based, no-fault or attorney is exhausted

55

patient payment

cash
HSA
flex spending
cafeteria accounts

56

liability

coers damages caused by negligence or fault of insured

57

uninsured/underinsured motorist

covers patient when person liable is uninsured or underinsured

58

medpay

limited to medical expenses
covers insured regardless of vehicle
available for other policies
using medpay will usually not result in premium increase for insured

59

PIP

personal injury prtection
similar to medpay but also covers lost wages
may be mandatory in "no fault" state

60

medical leins/healthcare lien

attorney represents patient
filing a lien is usually a simple procedure
may prevent bill being discounted by lawyer
insurance company may put patient and DC name on check

61

what is a HIPAA exemption example?

work related illness or injury

62

what information do you need for worker's comp cases?

employer
payer
date and time of injury/illness and how it occured

63

what do you need to verify for workers comp?

employer
empolyer knows of incident and report has been filed with insurance company
name of industrial insurance carrier
empolyer's WC policy #

64

what should the first report of injury contain?

patient information
employer information
payer information
accident or illness description
physician's assessment of patient
verification of other previous related illness/injury
estimated return to work status
treatment summary
permanent impairment or disability as a result of accident/injury

65

FECA

DCs are treated as physicians and a patient with FECA might choose a DC as provider (doesn't cover preventative care)

66

tricare

might now cover DC care

67

CHAMPUS
CHAMPVA

civialian health and medical program of uniformed services

68

government programs

FECA
tricare
CHAMPUS/CHAMPVA
VA
medicaid