NCCT - Medical Office Management - Part C - Financial Management

An inpatient is a term used to describe a patient who is admitted to a hospital and stays overnight for medical treatment or observation. This term is commonly used to distinguish between patients who are receiving care within the hospital setting versus those who receive care on an outpatient basis, where they do not stay overnight. The term "inpatient" is widely recognized and used in healthcare settings to refer to a patient who is occupying a hospital bed and receiving care within the hospital facility.

An unexpected event that may cause injury is called an accident.

Workers' Compensation is a form of insurance that is paid by the employer to provide cash benefits to workers who are injured or disabled while on the job. This type of insurance is specifically designed to cover medical expenses, lost wages, and rehabilitation costs for employees who have been injured in the course of their employment. It is a legal requirement in many countries to have workers' compensation insurance in place to protect both the employer and the employee in case of workplace accidents or injuries.

When correcting a handwritten error in a patient's chart, it is important to draw a line through the error to indicate that it is a mistake. Then, the correct information should be inserted, followed by dating and initialing it. This method ensures transparency and accountability in the documentation process and allows for easy identification of the correction. Writing over the error or scratching through it can make the chart difficult to read and may lead to confusion or misinterpretation of the information.

An outpatient is a patient who receives medical care at a hospital or health facility without being admitted as a bed patient. They typically visit the facility for consultations, diagnostic tests, or minor procedures and then return home the same day. This term is used to distinguish them from inpatients, who are admitted to the hospital and stay overnight for further medical treatment or observation. Outpatients are not required to stay overnight and receive care on an outpatient basis.

A preexisting condition refers to an injury, disease, or physical condition that already existed before the health insurance policy was issued. This means that the individual had the condition prior to obtaining the insurance coverage.

Medicare is a health program for people aged 65 and older under Social Security. It provides medical coverage for hospital stays, doctor visits, prescription drugs, and other healthcare services. Medicare is a government-funded program that helps older adults access necessary healthcare services and reduce their out-of-pocket expenses. It is separate from Medicaid, which provides healthcare coverage for low-income individuals and families.

A form to itemize deposits made to savings or checking accounts is called a deposit slip. This form is typically provided by the bank and allows the account holder to list the amount and type of funds being deposited, such as cash or checks. The deposit slip is then submitted along with the funds to ensure accurate and efficient processing of the deposit.

A person or institution that gives medical care is referred to as a provider. This term encompasses doctors, nurses, hospitals, clinics, and other healthcare professionals or facilities that offer medical services to patients. They are responsible for diagnosing and treating illnesses, injuries, and other medical conditions, as well as providing preventive care and promoting overall wellness. Providers play a crucial role in the healthcare system by delivering essential medical care to individuals in need.

A deductible is an amount that the insured must pay out of pocket before their insurance policy benefits kick in. It is a form of cost-sharing between the insured and the insurance company. Once the deductible is met, the insurance company will start covering the remaining costs as per the policy terms. It is a common feature in many types of insurance policies, including health insurance, auto insurance, and property insurance. The purpose of a deductible is to discourage small and frequent claims and to ensure that insurance coverage is primarily used for significant losses or expenses.

TRI-CARE is the correct answer because it is a civilian health and medical program of the Uniform Services. It provides healthcare benefits to active duty service members, retirees, and their dependents. Medicare, Medicaid, and Workers' Compensation are not specific to the Uniform Services and do not provide healthcare benefits exclusively to military personnel and their families.

A signature on the reverse side of a check is called an endorsement. This is when the payee of the check signs their name on the back, indicating that they are transferring the right to receive payment to someone else. Endorsements are necessary for the check to be deposited or cashed by someone other than the original payee.

A request for payment under an insurance contractor bond is called a claim. When a contractor fails to fulfill their obligations or breaches the terms of the bond, the party that suffered a loss can file a claim to receive compensation. The claim is a formal request for payment, supported by evidence of the damages incurred. The insurance company will then evaluate the claim and determine if it meets the criteria for coverage under the bond. If approved, the insurance company will provide the necessary funds to cover the losses.

A participating physician is a doctor who agrees to accept an insurance company's pre-established fee as the maximum amount to be collected. This means that the doctor has agreed to be part of the insurance company's network and has agreed to accept the predetermined payment from the insurance company for the services provided to the insured individuals. By being a participating physician, the doctor can provide services to patients who have insurance coverage with that particular insurance company.

Explanation of Benefits (EOB) is a recap sheet that accompanies a Medicare or Medicaid check, showing the breakdown and explanation of payment on a claim. It provides detailed information about the services provided, the amount billed, the amount covered by insurance, and any remaining balance that the patient may owe. The EOB helps the patient understand how their insurance benefits were applied to the claim and allows them to verify that the payment was accurate. It is an important document for both the patient and the healthcare provider to track and reconcile payments.

Medicaid is a government program that provides health insurance to low-income individuals and families. It is specifically designed to cover medical expenses for those who have limited income and resources. Therefore, it is the most suitable insurance option for low-income patients. Medicare, on the other hand, is a federal health insurance program for individuals aged 65 and older, as well as certain younger individuals with disabilities. Tri-Care is a health care program for military personnel and their families, and Blue Cross/Blue Shield is a private health insurance provider.

Partial disability refers to an injury that hinders a worker's ability to perform some, but not all, of their regular job functions. This means that the worker may still be able to perform certain tasks but is limited in their overall capacity to work. It signifies a temporary or partial loss of physical or mental abilities, which may require adjustments or accommodations in the workplace. This is different from permanent disability, where the worker is completely unable to perform any of their regular job functions, and total disability, where the worker is unable to perform any type of work. Resultant disability is not a commonly used term in this context.

A payment made periodically to keep an insurance policy in force is called a premium. This is the amount of money that an individual or business pays to the insurance company in exchange for coverage. The premium can be paid monthly, quarterly, semi-annually, or annually, depending on the terms of the insurance policy. By paying the premium on time, the policyholder ensures that their insurance coverage remains active and that they will be protected in the event of a covered loss or claim.

Fee-for-service is a method of charging where a physician presents a bill for each service rendered. This means that the patient is charged for each individual service or procedure that they receive, rather than a lump sum or monthly fee. This allows for more transparency in billing and allows the patient to see exactly what services they are being charged for. It is a common payment model in healthcare where the healthcare provider is reimbursed based on the services provided.

A record of debits, credits, and balances is referred to as a patient's ledger. This ledger is used to keep track of financial transactions related to the patient, including charges, payments, and outstanding balances. It provides a comprehensive overview of the patient's financial history and is an essential tool for billing and accounting purposes in healthcare settings.

A Health Maintenance Organization (HMO) is an organization that offers health insurance at a fixed monthly premium with little or no deductible and works through a primary care provider. HMOs typically require members to choose a primary care physician (PCP) who coordinates their healthcare and provides referrals to specialists within the network. This type of organization focuses on preventive care and emphasizes the importance of regular check-ups and screenings. By utilizing a network of healthcare providers, HMOs aim to provide cost-effective and comprehensive healthcare services to their members.

The CMS-1500 form is used by non-institutional providers and suppliers to bill Medicare for Part B covered services. This form is specifically designed for healthcare professionals to submit their claims for reimbursement. It includes important information such as patient demographics, diagnosis codes, procedure codes, and the provider's information. The CMS-1500 form is widely recognized and accepted by Medicare and other insurance companies for billing purposes.

The International Classification of Disease, 9th Revision, Clinical Modification (ICD-9-CM) is used to code diagnoses. This classification system is widely used in healthcare settings to classify and code diseases, injuries, and other health conditions. By assigning specific codes to diagnoses, healthcare professionals can accurately document and track patient conditions, which is essential for clinical decision making, research, and reimbursement purposes.

A person who belongs to a group insurance plan is called a subscriber. This term is commonly used to refer to an individual who enrolls in and pays for coverage under a group insurance policy. The subscriber is typically the policyholder and is responsible for paying premiums and managing the insurance plan on behalf of themselves and any dependents included in the coverage.

The correct answer is "USUAL, CUSTOMARY AND REASONABLE". This term refers to insurance plans that will cover a physician's full charge if it falls within the normal range of charges for that particular service. It ensures that the insurance company will only pay for charges that are considered usual, customary, and reasonable, preventing overcharging or excessive fees.

A rider added to a policy to provide additional benefits for certain conditions is called a dread disease rider. This rider is specifically designed to provide coverage for specific serious illnesses or diseases, such as cancer, heart attack, or stroke. It offers additional financial protection to policyholders in case they are diagnosed with any of the covered conditions. Unlike other riders that provide general benefits, the dread disease rider focuses on specific illnesses, ensuring that policyholders have the necessary financial support to cope with the high costs associated with these conditions.

An assignment of benefits is an agreement in which a patient transfers their right to receive payment for medical services to another party. This allows the healthcare provider to directly bill and receive payment from the patient's insurance company or third-party payer. This arrangement is commonly used in situations where the patient wants to avoid the hassle of dealing with insurance claims and reimbursement themselves. By assigning the benefits to the healthcare provider, the patient ensures that the provider will be paid directly for the services rendered.

When a patient has health insurance, the percentage of covered services that is the responsibility of the patient to pay is known as coinsurance. Coinsurance refers to the portion of the medical expenses that the patient is required to pay out of pocket, usually expressed as a percentage of the total cost. This is different from a pre-defined policy or comprehensive coverage, which do not specifically refer to the patient's responsibility for payment. An "in percent policy" is not a commonly used term in the context of health insurance.

FICA, or the Federal Insurance Contributions Act, provides benefits for Social Security. Social Security is a government program that provides financial support to retired workers, disabled individuals, and the dependents of deceased workers. FICA taxes are deducted from employees' paychecks and are used to fund Social Security benefits. Therefore, FICA directly contributes to the provision of Social Security benefits.

An agent of an insurance company who solicits or initiates contracts for insurance coverage and services, and is the policyholder for the insurer is called an insurance agent.

Catastrophic health insurance provides coverage for severe or lengthy illnesses and disabilities that come with high treatment costs. This type of insurance is designed to protect individuals from financial burden in case of major health issues. It typically has high deductibles and lower premiums, and kicks in after the deductible is met. Catastrophic health insurance is suitable for individuals who are generally healthy and do not require frequent medical care, but want coverage for potential major medical expenses.

Using an "E" code in insurance coding designates the classification of environmental events, such as poisoning. This means that when coding for insurance purposes, an "E" code is used to indicate cases related to environmental events that caused poisoning. This classification helps in identifying and tracking cases of poisoning caused by various environmental factors, allowing for proper documentation and analysis of such incidents in insurance claims.

An adjuster is a person who represents either party of an insurance claim. They are responsible for investigating and evaluating the claim, determining the extent of the insurance coverage, and negotiating settlements. They act as a mediator between the policyholder and the insurance company, ensuring that the claim is handled fairly and accurately. The adjuster plays a crucial role in the claims process, helping to resolve disputes and ensuring that the policyholder receives the appropriate compensation.

Coordination of benefits refers to the process of preventing an insured individual from receiving duplicate payments for losses under multiple insurance policies. This is done to ensure that the insured does not receive more than the actual amount of the loss. By coordinating benefits, insurance companies can determine which policy is primary and which is secondary, and then coordinate the payment accordingly. This helps to avoid overpayment and ensures that the insured is not financially benefited from the same loss by multiple insurance policies.

Co-payment is a type of insurance where the insured pays a specific amount per unit of service, and the insurer pays the rest of the cost. This means that the insured is responsible for a portion of the cost of each service or treatment they receive, while the insurance company covers the remaining expenses. Co-payment is a common feature in many health insurance plans, and it helps to share the financial burden between the insured and the insurer.

Major medical insurance is a type of insurance that is designed to cover the costs of medical expenses resulting from a catastrophic illness. This type of insurance typically has higher coverage limits and lower deductibles compared to other types of health insurance. It provides financial protection against significant medical expenses such as surgeries, hospital stays, and long-term treatments. Major medical insurance is essential for individuals who want comprehensive coverage for serious illnesses and injuries.

Payment for hospital charges incurred by an insured person because of injury or illness is referred to as hospital benefits. This term is used to describe the financial assistance provided by insurance companies to cover the costs associated with hospitalization, such as medical procedures, tests, medications, and room charges. Hospital benefits are an essential component of health insurance plans, ensuring that individuals receive the necessary medical care without incurring excessive financial burden.

The correct answer is W-4. The W-4 form is used by employees to indicate their withholding allowances for federal income tax purposes. It helps employers determine how much federal income tax to withhold from an employee's paycheck. The W-2 form, on the other hand, is a form that employers use to report wages and taxes withheld for each employee. The 1040 form is used by individuals to file their annual federal income tax return. The W-3 form is used by employers to report wages and taxes for all employees to the Social Security Administration.

An extended care facility is a skilled nursing facility that provides specialized care to patients after they are discharged from a hospital. This type of facility offers medical services and rehabilitation therapies to help patients recover and regain their independence. It is different from a nursing home, which typically provides long-term care for elderly individuals who may not require specialized medical attention. Therefore, the correct answer is extended care facility.

In order for an insurance claim to be considered valid, a notice of insurance claim or proof of loss must be filed within a designated time limit. If this time limit is not met, the claim can be denied.

A grace period is an interval after a payment is due to the insurance company in which the policy holder may make payments, and still, the policy remains in effect. During this period, the policy holder has the opportunity to make the payment without any penalty or loss of coverage. This allows the policy holder some flexibility in making payments while ensuring that their policy remains active.

The Tri-Care fiscal year is from October 1 to September 30. This means that the financial year for Tri-Care starts on October 1st and ends on September 30th of the following year.

E/M codes are located in the CPT (Current Procedural Terminology) manual. CPT is a standardized coding system used for reporting medical procedures and services. It is published by the American Medical Association (AMA) and is widely used by healthcare providers, insurance companies, and other entities involved in medical billing and reimbursement. The CPT manual contains a comprehensive list of codes for various medical services, including evaluation and management (E/M) codes which are used to describe physician-patient encounters.

The correct answer is "BENEFITS" because in an insurance policy, the sum of money provided for covered services is referred to as benefits. This refers to the amount that the policyholder is entitled to receive from the insurance company for any covered expenses or services, such as medical treatments or repairs. The benefits can vary depending on the specific policy and coverage, and they are typically outlined in the insurance contract.

The correct answer is "CUURENT PROCEDURE TERMINOLOGY." This is because the question asks for the name of the reference procedural code book that uses a numbering system developed by the AMA. Current Procedure Terminology (CPT) is a medical code set that is used to report medical, surgical, and diagnostic procedures and services. It is published by the American Medical Association (AMA) and is widely used in the healthcare industry for billing and documentation purposes.

As part of the office bookkeeping procedures, the physician's bank statements should be reconciled with the checkbook. This means that the transactions recorded in the checkbook should be compared and matched with the transactions listed in the bank statements. By doing this reconciliation, any discrepancies or errors can be identified and corrected, ensuring that the checkbook accurately reflects the financial transactions of the physician's office.

Cash payments made as benefits are known as indemnities. Indemnities are a form of compensation that is provided to individuals to cover losses or damages. In the context of benefits, indemnities refer to cash payments made to individuals as a form of compensation for certain expenses or losses incurred. This could include payments for medical expenses, property damage, or other types of financial losses. Indemnities are typically provided as a form of reimbursement and are meant to help individuals recover from the financial impact of a specific event or situation.

Comprehensive coverage in insurance refers to a policy that provides a wider range of coverage for diseases or accidents compared to a limited clause. It offers greater protection and indemnity payment for various medical expenses and damages. This type of coverage is more extensive and inclusive, covering a broader scope of risks and potential losses.

Pre-certification is a method used for determining whether a particular service or procedure is covered under a patient's policy. This process involves obtaining approval from the insurance company before the service or procedure is performed. The purpose of pre-certification is to ensure that the patient's insurance will cover the cost of the service and to prevent any unexpected financial burden on the patient. It allows both the patient and the healthcare provider to be informed about the coverage and potential costs associated with the service or procedure.

Modifiers can be added to CPT codes to indicate that a procedure or service has been altered in some way. CPT codes are used for reporting medical procedures and services, and modifiers provide additional information about the specific circumstances of the service provided. Modifiers can indicate things like multiple procedures performed, bilateral procedures, or services provided by a different physician. Therefore, the correct answer is CPT.