CIMO Chapter 1 Review Page 23-25

Using Terminology 1. R accounting 2. K accounts receivable (AR) 3. I capitation 4. N coinsurance 5. F copayment 6. P diagnosis code 7. C encounter form 8. A- explanation of benefits (EOB) 9. M fee-for-service 10. L - HMO 11. S health plans 12. J- managed care 13. B- patient information form 14. D- payer 15. G policyholder 16. O - preferred provider organization (PPO) 17. H - premium 18. Q- procedure code 19. E- remittance advice (RA)

Checking Your Understanding 1. True - Many patient information forms contain a place for the patient to sign to authorize the patient's health plan to send payment directly to a provider 2. False - CPT codes have eight digits. 3. False - coinsurance refers to a small fixed fee that must be paid by the patient at the time of an office visit. Choose the best answer.

1. b) insurance coverage a patient information form contains information such as the name address, employer, and: 2. c) managed care health plan A health maintenance organization (HMO) is one example of 3. c) copayment In a managed care health plan, a copayment is usually collected from the patient at the office visit. 4. b) ICD The most commonly used system of medical procedure code is found in the ICD 5. b) encounter form Information about a patients medical procedures that is needed to create an insurance claim is found on the encounter form Applying Your Knowledge List ten steps in the billing and reimbursement cycle 1. Preregister patients 2. establish financial responsibility 3. check in patients 4. check out patients 5. review-coding compliance 6. check billing compliance 7. prepare and transmit claims 8. monitor payer adjudication 9. generate patient statements 10. follow up payments and collections Thinking About It 1.1 Verification of insurance is importance to make sure the patient plan is active It is important to be aware of the restrictions and to inform the patient as to any restrictions that the policy may have before beginning medical treatment. Verification of the type insurance plan is to know what patient services are covered. It is also necessary to identify if a patients has a deductible to pay before the medical insurance company will reimburse costs. 1.2 Co-payment are required amounts the patients must pay, and it best to collect it during checkin to make the it easier for accountants to look at the insurance forms sent in by insurance carriers, and then extrapolate the amount of copayments you should have received.