Medisoft Test Chapters 4 - 11

A chart number is a unique identifier assigned to a patient in a medical setting. It is used to keep track of the patient's medical records, treatment history, and other important information. This number allows healthcare professionals to easily access and update the patient's records, ensuring efficient and accurate care.

A grouping of transactions for visits to physician's offices is known as a case. This term is commonly used in medical billing and coding to refer to a collection of related medical services provided to a patient during a single encounter with a healthcare provider. A case can include various procedures, examinations, consultations, and treatments that are documented and billed together. It helps in organizing and tracking patient visits and ensures accurate reimbursement for the services rendered.

A folder that contains all records pertaining to a patient is referred to as a chart. A chart is a comprehensive collection of medical documents, test results, treatment plans, and other important information related to a patient's healthcare. It serves as a centralized location for healthcare professionals to access and update patient information, ensuring continuity of care and facilitating effective communication between different healthcare providers. The chart is an essential tool for tracking the patient's medical history, monitoring progress, and making informed decisions about their healthcare.

Charges refer to the amount billed by a provider for specific services rendered. This can include fees for medical treatments, consultations, procedures, or any other services provided by the healthcare provider. Charges are typically determined based on the complexity and duration of the service, as well as any additional factors such as equipment or medication used during the service.

A sponsor is the active duty service member on TRICARE/government insurance. This individual is responsible for enrolling their dependents in the TRICARE program and ensuring that they receive the necessary healthcare benefits. The sponsor acts as a point of contact for any issues or concerns related to the insurance coverage and plays a vital role in coordinating healthcare services for their family members.

A report that shows the activities in a 24-hour period is referred to as a day sheet. This term is commonly used in various industries to summarize the events, tasks, and transactions that occurred within a specific day. It provides a concise overview of the day's activities, allowing individuals to track progress, identify trends, and make informed decisions based on the information presented. The day sheet is a valuable tool for monitoring and managing daily operations, ensuring efficiency and productivity.

The first carrier to whom claims are submitted is referred to as the primary insurance carrier. This suggests that there may be multiple insurance carriers involved in the claims process, and the primary carrier is the initial point of contact for submitting claims. This term helps to differentiate the primary carrier from any secondary or additional insurance carriers that may be involved in the process.

A physician who recommends another physician is referred to as a "referring provider." This term is used to describe a healthcare professional who directs a patient to see another healthcare professional for specialized care or treatment. The referring provider plays a crucial role in coordinating the patient's healthcare by identifying the need for specialized services and facilitating the referral process.

Adjustments are changes made to the patient's account, which refers to the financial record or billing information related to their medical treatment. These adjustments can include any modifications or updates made to the charges, payments, or insurance claims associated with the patient's healthcare services. Keeping an accurate and up-to-date account is crucial for proper billing and reimbursement processes.

A collection agency is an outside firm that specializes in collecting payments on delinquent accounts. Delinquent accounts refer to accounts that are past due or have not been paid within the agreed-upon timeframe. These accounts may have missed one or more payments or have been outstanding for a significant period of time. The collection agency's role is to contact and negotiate with the debtor in order to recover the outstanding amount on behalf of the original creditor.

A guarantor is an individual who agrees to take responsibility for another person's financial obligations in case they are unable to fulfill them. In the context of insurance, a guarantor is someone who holds the insurance policy on behalf of the patient. This means that while the patient receives the benefits of the insurance coverage, the guarantor is ultimately responsible for paying the insurance premiums and any outstanding bills. Therefore, the correct answer in this case is "guarantor."

Payments are monies paid to the medical practice by the patient and/or insurance carrier(s). This can include payments made directly by the patient or payments made by insurance companies on behalf of the patient. Payments are typically made to cover the cost of medical services provided by the practice.

An established patient is defined as someone who has previously been seen by a physician in the same practice within a certain period of time. In this case, the correct answer is 3 years, meaning that if a patient has been seen by a physician within the same practice within the past 3 years, they are considered an established patient. This timeframe allows for continuity of care and familiarity with the patient's medical history.

This question is asking about the number of years that a new patient has not received services in the past. The correct answer is "three," indicating that the patient has not received any services for the past three years.

Cycle billing is a type of billing where patients are divided into groups and receive statements throughout the month. This approach allows for a more even distribution of billing and helps to manage the workload of the billing department. Instead of sending out all statements at once, the billing is staggered throughout the month, ensuring that patients receive their bills at different times. This can help to improve cash flow for the healthcare provider and make it easier for patients to manage their payments.

A patient aging report is a document that lists a patient's balance, date, amount of last payment, and telephone number. This report helps healthcare providers track and monitor the aging of patient accounts receivable, allowing them to identify unpaid balances and follow up with patients for payment. It provides a snapshot of outstanding balances and helps in managing the revenue cycle effectively.

A tickler is a tool or system used to remind someone to follow up on an account. It helps keep track of important tasks or deadlines related to the account and ensures that nothing falls through the cracks.

MultiLink codes are a group of procedure codes related to a single activity. These codes are used to classify and track specific activities within a larger process or workflow. They help in organizing and categorizing activities, making it easier to analyze and report on specific procedures.

The correct answer is "office hour breaks" because it refers to the specific periods of time when the physician is not available to see patients. These breaks are typically scheduled throughout the day to allow the physician time for administrative tasks, personal needs, or other commitments outside of patient appointments.

An electronic document that shows a patient's dates of services, charges, amount paid, and amount denied by the insurance carrier is known as an ERA (Electronic Remittance Advice). This document provides detailed information about the financial transactions between the healthcare provider and the insurance company, allowing for accurate tracking of payments and denials.

A patient statement is a list of patient procedures, dates, and the amount the patient owes. This statement is typically provided by the healthcare provider to the patient, detailing the services rendered, the dates of those services, and the corresponding costs that the patient is responsible for paying. It serves as a summary of the patient's financial obligations and helps them understand the charges and payments related to their healthcare.

A payment schedule is a document stating the amount the payer agrees to pay for services based on the contract rate of reimbursement. This document outlines the specific payment amounts and terms agreed upon by both parties involved. It serves as a reference for the payer to ensure that they are making the correct payments according to the agreed-upon rates.

The physician's notes about a patient's conditions and/or diagnoses serve as a record of the treatment and progress of the patient. These notes provide important information about the patient's medical history, the treatments they have received, and the progress they have made over time. Keeping a detailed record of treatment and progress is crucial for effective medical care and continuity of care for the patient. Therefore, the correct answer is "record of treatment and progress."

The practice analysis report analyzes revenue for a specific time period. This report examines the income generated by the practice during a particular timeframe, providing insights into the financial performance and profitability of the business. It helps identify trends, patterns, and areas of improvement in revenue generation, allowing the practice to make informed decisions and strategies to enhance its financial stability and growth.

Uncollectable accounts refer to accounts receivable that are deemed unlikely to be collected. These accounts are considered as losses for the company and are written off. When customers fail to respond or are unable to pay their debts, the company removes these accounts from their books as they are considered as uncollectable. This helps the company to accurately reflect their financial position and avoid overestimating their assets.

A patient day sheet is a document that summarizes the activities of a patient on a specific day. It includes information such as appointments, procedures, medications, and any other relevant details. This sheet helps healthcare professionals keep track of the patient's progress and plan their care accordingly. It serves as a record of the patient's daily activities and can be used for reference and communication between different healthcare providers involved in the patient's care.

The procedure day sheet is a report that lists the procedures performed on a given day in numerical order. This means that the procedures are arranged in a sequential manner based on their assigned numbers or codes. This allows for easy reference and tracking of the procedures performed on that specific day.

Navigator buttons are ones that simplify tasks in moving from one entry to another. These buttons typically provide options to navigate through different pages, sections, or entries within a system or application. They help users easily move forward, backward, or jump to specific sections, enhancing the overall user experience and making it more efficient to navigate through the content.

A capitated plan is one where payments are made to the physician by managed care. In a capitated plan, the healthcare provider receives a fixed amount of money per patient enrolled in the plan, regardless of the actual services provided. This incentivizes providers to deliver cost-effective care and manage resources efficiently. It also shifts the financial risk from the insurer to the healthcare provider, as they are responsible for providing all necessary services within the fixed payment amount.

Capitated payments are ones made to a physician for services provided under a managed care plan. In a capitated payment model, the physician receives a fixed amount of money per patient per month, regardless of the actual services provided. This payment method incentivizes physicians to provide efficient and cost-effective care to their patients. It also helps to control healthcare costs by shifting the financial risk from the payer to the provider.

The correct answer is "charges" because the statement is referring to the list of amounts that are still owed after receiving the insurance payment. These amounts are typically referred to as charges, which are the expenses or fees that need to be paid by the patient or the insurance company after the initial payment has been made.

A filter is a condition that data must meet in order to be selected. It is used to sort and narrow down data based on specific criteria or requirements. Filters are commonly used in various applications and systems, such as database queries, email clients, and search engines, to refine and display only the relevant information that meets the specified conditions.

A ledger is a record that contains all the financial activities and transactions related to a patient's account. It provides a comprehensive overview of the patient's financial history, including details of payments, charges, and any adjustments made. The ledger is an essential tool for tracking and managing the financial aspects of a patient's account, ensuring accuracy and transparency in billing and financial reporting.

A fee schedule is a document that outlines the predetermined amount that a provider will be paid for each procedure. It serves as a guide for determining the costs associated with specific medical services and helps ensure transparency and consistency in billing. By having a fee schedule in place, both the provider and the patient can have a clear understanding of the expected costs for each procedure.

The listing of time slots for a specific provider for a specific day is known as "office hours." This term is commonly used to refer to the designated time period during which a provider is available to see patients or clients. It helps in organizing and managing appointments and ensures that both the provider and the patients are aware of the available time slots for scheduling appointments.

An insurance aging report is a list that tracks the amount of time it takes for a payer to respond to insurance claims. It provides information on how long the claims have been pending and helps identify any unpaid claims. This report is useful for healthcare providers to monitor the status of their claims and take appropriate actions to follow up with the insurance companies for timely reimbursement.

An aging report is a list that categorizes the amounts owed to a practice based on the length of time that has passed since the debt was incurred. It helps the practice to identify and manage overdue payments by organizing them into different time periods, such as 30 days, 60 days, or 90 days past due. This allows the practice to prioritize collection efforts and take appropriate actions to recover the outstanding amounts.

A payment day sheet is a report that lists payments received by the provider. This means that the provider, such as a healthcare facility or service provider, receives payments from various sources and keeps track of them using a payment day sheet. The sheet helps the provider keep a record of the payments received, which is important for financial management and tracking revenue.

A collection list is a tool for tracking activities needed as part of the collection process. It helps in organizing and prioritizing the tasks involved in collecting outstanding payments. By maintaining a collection list, the collection agency can keep track of the accounts that need attention, monitor the progress of collection efforts, and ensure that all necessary steps are taken to recover the unpaid amounts. This tool helps streamline the collection process and ensures that no accounts are overlooked or neglected.

A "standards" statement refers to a comprehensive list of all charges incurred, regardless of whether insurance has covered the transactions. This statement follows a set of guidelines or norms that ensure all charges are accounted for, providing a complete overview of the financial transactions.