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Related Flashcards
Related Topics
Cards In This Set
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New patient (NP)
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A patient who has not received professional services from a provider (or another provider with the same specialty in the same practice) within the past three years.
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Returning patient 9established patient)
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Patient that has seen the provider (or another provider who has the same specialty) within the past 3 years.
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Information needed for new patients
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1-Preregistration and scheduling information
2-Medical history 3-Patient/guarantor information & insurance Information 4-Assignment of benefits 5-Acknowledgement of Receipt of Notice of Privacy Practices |
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Referring physician
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A referring physician send a patient to another physician for treatment.
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Assignment of benefits
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Authorization by a policy-holder that allows a health plan to pay benefits directly to a provider
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Subscriber
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The insured.
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3 steps to establish financial responsiblity
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1-Verify patient's eligibility for insurance benefits
2-Determine preauthorization & referral requirements 3-Determine the primary payer if more than one insurance plan is in effect. |
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3 things to verify with the patient's insurance co.
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1-Patient's eligibility for benefits
2-Amount of copay 3-If the planned encounter is covered. |
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Primary insurance
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Plan that pays first when patient has more than one insurance plan. The primary plan is the plan the patient has had the longer period of time.
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Supplemental insurance
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Fill the gap insurance policy
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Secondary insurance
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A second claim is sent to the secondary payer after the payment is received for the primary claim.
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Coordination of benefits (COB)
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A clause in an insurance policy that explains how the policy will pay if more than one insurance policy applies to the claim.
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Birthday rule
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The rule states that the parent whose day of birth is earlier in the calendar year is primary.
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Encounter form
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A listing of the diagnoses, procedures, and charges for a patient's visit; also called the superbill. Is completed by the provider during visit. The provider signs and dates it. Encounter forms should be prenumbered for accurate charge capture.
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Charge capture
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Office procedures that ensure that all billable services are recorded and reported for payment.
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