What is Billing and Scheduling? Flashcards

How Well Do You Know the Following Billing and Scheduling? Answer these quiz based flashcards based on Billing and Scheduling and check your knowledge. Learn key terms, definitions, and much more related to Organic Molecules with our flashcards quizzes with ease. ​

17 cards   |   Total Attempts: 188
  

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Cards In This Set

Front Back
What does SOMB stand for?!
Schedule of Medical Billing
SOMB
  • Outlines fees for insured services
  • Outlines rules and regulations oh how doctors may bill the province
What is a fee for service?
  • A set fee that a Physician is paid for each insured service
  • Must be deemed medically necessary- considered necessary when if the service is not done it would affect their medical condition
What information do MOA's need to bill Alberta Health and Wellness?
  • Patients First and Last name
  • Date of birth
  • PHN (insured patient)
  • Physicians Prac Number
  • Faculty Number
  • Business Arrangement number
  • Date of Service
  • Billing Code
  • Diagnostic Code
What is RMB?
Reciprocal Medical Billing Billing to the other provinces/territories for fee for service
  • Reimbursement is only for insured medical services
  • Amounts are based on rates/rules established by servicing provinces/territories
What Province does not participate in the Reciprocal agreement?
Quebec
Federally Insured Individuals
  • First Nations people living on reserves
  • Inuit
  • Serving members of the Canadian Forces
  • Eligible veterans
  • Inmates in Federal penitentiaries
  • Some groups of refugee claimants
UNINSURED SERVICES
  • Services deemed not medically necessary
  • Non -medically required surgery like cosmetic surgery
  • Vision care ex, eye exam
  • Routine Dental care services ex, cleaning
  • Vaccinations for travel purposes
UNINSURED SERVICES CONTINUED
  • Reproductive/fertility
  • Health services requested by 3rd party (employement)
  • Medical forms and notes
  • Psychologist services
  • Private and semi-private hospitals
  • Ambulance services
  • Procedures that are experimental
  • Hearing aides, medical & surgical appliances
WBC
Workers Compensation Board
  • Premiums are paid by employer
  • Physician’s first report form regarding a patient must be submitted within 48 hours of treatment
  • Must mention on schedule when an appointment is WBC
Billing code
This is the code that is used to decide how much the doctor is going to get paid for each insured service
Diagnostic code
This is the code that is used to decide what the patient was seen for at the clinic
Driver's Medical
For those over 74.5 years old
Removal of Sutures
15 minute appointment
When should 1 hour appointments be booked?
The last appointment before lunch or the last appointment of the day