reimbursement and personal health records
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The University of Tennessee, Knoxville *
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Course
3505
Subject
Health Science
Date
Feb 20, 2024
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20
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Electronic Medical Records / Reimbursement and Personal Health Records Reimbursement and Personal Health Records © 2023 PF High School, LLC © 2023 Career Step, LLC © 2023 Education Holdings 1, LLC © 2023 Sokanu Interactive Page: 1 0f20
Electronic Medical Records / Reimbursement and Personal Health Records Lesson 3 Overview Your third lesson begins with healthcare reimbursement through third-party payers and the revenue cycle. The textbook discusses different coding systems for diagnosis and services rendered at a patient’s visit and how these are related to medical necessity, in addition to the documents needed for proper claims to the health plans. The lesson ends with types of personal health records, advantages of using a patient health record, how to create a personal health record, and patient portals that are tethered through EHRs. © 2023 PF High School, LLC Page: 2 0f 20 © 2023 Career Step, LLC © 2023 Education Holdings 1, LLC © 2023 Sokanu Interactive
Electronic Medical Records / Reimbursement and Personal Health Records Lesson Objectives « Understand the reimbursement process, coding systems, and proper documentation for medical necessity of services * Describe the use and advantages of the personal health record, as well as how it can be maintained © 2023 PF High School, LLC © 2023 Career Step, LLC © 2023 Education Holdings 1, LLC © 2023 Sokanu Interactive Page: 3 0f 20
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Electronic Medical Records / Reimbursement and Personal Health Records Understand the Reimbursement Process, Coding Systems, and Proper Documentation for Medical Necessity of Services © 2023 PF High School, LLC © 2023 Career Step, LLC © 2023 Education Holdings 1, LLC © 2023 Sokanu Interactive Page: 4 0f 20
Electronic Medical Records / Reimbursement and Personal Health Records Using the EHR for Reimbursement Read this assignment. Then read Chapter rcode=ashworth-308258&srcou=16104) in your textbook. External Reference(https:/lessons.pennfoster.edu/savi/427139_1/story.html) © 2023 PF High School, LLC © 2023 Career Step, LLC © 2023 Education Holdings 1, LLC © 2023 Sokanu Interactive Page: 5 0f 20
Electronic Medical Records / Reimbursement and Personal Health Records Key Terms Answer Key Click to view HIT130 Key Terms Answer Key.pdf(https://courses.portal2learn.com/content/enforced/27291- HIT130 VE 1/Lesson 3/Section 1/1652/HIT130 Key_ Terms Answer Key.pdf) © 2023 PF High School, LLC © 2023 Career Step, LLC © 2023 Education Holdings 1, LLC © 2023 Sokanu Interactive Page: 6 0f 20
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Electronic Medical Records / Reimbursement and Personal Health Records Self Assessment: Understand the Reimbursement Process, Coding Systems, and Proper Documentation for Medical Necessity of Services =0 Open Link © 2023 PF High School, LLC Page: 7 0f 20 © 2023 Career Step, LLC © 2023 Education Holdings 1, LLC © 2023 Sokanu Interactive
Electronic Medical Records / Reimbursement and Personal Health Records Describe the Use and Advantages of the Personal Health Record, as Well as How It Can Be Maintained © 2023 PF High School, LLC Page: 8 of 20 © 2023 Career Step, LLC © 2023 Education Holdings 1, LLC © 2023 Sokanu Interactive
Electronic Medical Records / Reimbursement and Personal Health Records The Personal Health Record Read this assignment. Then read Chapter External Reference(https:/lessons.pennfoster.edu/savi/427139_2/story.html) © 2023 PF High School, LLC © 2023 Career Step, LLC © 2023 Education Holdings 1, LLC © 2023 Sokanu Interactive Page: 9 0f 20
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Electronic Medical Records / Reimbursement and Personal Health Records Self Assessment: Describe the Use and Advantages of the Personal Health Record, as Well as How It Can Be Maintained =0 Open Link © 2023 PF High School, LLC Page: 10 of 20 © 2023 Career Step, LLC © 2023 Education Holdings 1, LLC © 2023 Sokanu Interactive
Electronic Medical Records / Reimbursement and Personal Health Records Unit Review In this Review, you'll complete practice activities, which may include a Practice Quiz, to help you test your knowledge. The Review activities and Practice Quiz are ungraded. You can complete the Review activities and Practice Quiz as many times as you want. When you feel ready, you can complete the graded assessment. © 2023 PF High School, LLC © 2023 Career Step, LLC © 2023 Education Holdings 1, LLC © 2023 Sokanu Interactive Page: 11 0£ 20
Electronic Medical Records / Reimbursement and Personal Health Records Try to define the term before you flip the card. You should write down the term and definition in your notebook. Consider making your own note cards to study with. Third-Party Payer Definition: Any insurance company, including Medicare and Medicaid Definition: First-party payer; the person legally responsible for the Guarantor 5 patient's account Second Party Defir.fition: Th.e provider, or person providing the healthcare or medical service HIPAA 5010 Definition: An electronic claim format used to submit claims to Medicare, Medicaid, and other health insurance payers Electronic Data Interchange (EDI) Definition: An electronic submission format used in lieu of printing claims Revenue Cycle Definition: Refers to the entire process of scheduling a patient and continuing through the collection of payment for services rendered Eligibility Definition: Benefits from the health plan that the patient is entitled to receive Medical Coding Definition: A system of numeric or alphanumeric codes used for diagnoses, procedures, and treatments, which standardizes claims submitted Coding Variances Definition: Also known as mistakes; occur from computer or human error Pay for Performance (P4P) Definition: An outcome-based payment model that rewards providers for delivering evidence-based care according to specific standards and for documenting compliance with those standards Medical Necessity Definition: Refers to the legal doctrine that holds medical services rendered as reasonable and necessary according to generally accepted clinical standards Fraud Definition: A misrepresentation of medical services provided to deceive or mislead another person or entity Abuse Definition: Unintentional deception in which a provider inappropriately bills for services that aren't medically necessary Personal Health Record (PHR) Definition: A confidential, comprehensive electronic or paper-based record of health information that's controlled by an individual and can be easily accessed, managed, or shared Paper-Based PHRs Definition: Traditional form of collecting paper records; usually organized into three-ring-binders with dividers In Case of Emergency (ICE) Notifications Definition: Notifications set to specify what information is available for emergency personnel in the event of an accident or illness Medical Power of Attorney Definition: A person who makes medical decisions on the patient's behalf if he or she is unable to do so © 2023 PF High School, LLC © 2023 Career Step, LLC © 2023 Education Holdings 1, LLC © 2023 Sokanu Interactive Page: 12 0f 20
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Electronic Medical Records / Reimbursement and Personal Health Records Practice Quiz: Reimbursement and Personal Health Records This Practice Quiz is ungraded, and you can take it as many times as you want. When you finish, you’ll be able to view whether your answer was correct or incorrect. Click “View Feedback” after each item to see an explanation for the correct answers. You won’t be allowed to go back and click “View Feedback” again, so be sure to note of topics you may need to study more. Question 1 (5.00 Points) Medicare is an example of a (Choose one) a) third-party payer. b) tertiary payer. c) guarantor. d) secondary payer. Question 2 (5.00 Points) Another name for coding mistakes is (Choose one) a) variances. b) accuracy. c) descriptions. d) ranges. Question 3 (5.00 Points) ICD-10-CM coding manuals (Choose one) a) contain anesthesia codes. b) include procedural coding for outpatient provider services. c) include codes for durable medical equipment used by Medicare. © 2023 PF High School, LLC Page: 13 of 20 © 2023 Career Step, LLC © 2023 Education Holdings 1, LLC © 2023 Sokanu Interactive
Electronic Medical Records / Reimbursement and Personal Health Records d) contain a tabular list of diseases. Question 4 (5.00 Points) When creating a claim in SimChart for the Medical Office, which tab is used to enter the services provided to the patient? (Choose one) a) Patient Info b) Charge Capture c) Encounter Notes d) Payer Info Question 5 (5.00 Points) The CPT coding system (Choose one) a) was developed by the AAMA. b) consists of five-digit codes. c) consists of alphanumeric codes. d) consists of three- to five-digit codes. Question 6 (5.00 Points) Ultrasound would be coded from (Choose one) a) Radiology. b) E&M. c) Volume I. d) Medicine. Question 7 (5.00 Points) © 2023 PF High School, LLC Page: 14 of 20 © 2023 Career Step, LLC © 2023 Education Holdings 1, LLC © 2023 Sokanu Interactive
Electronic Medical Records / Reimbursement and Personal Health Records A tetanus injection would be coded from (Choose one) a) Medicine. b) Category II. c) Volume I. d) E&M. Question 8 (5.00 Points) codes are supplemental codes used to help researchers collect data, track illness and disease, and measure quality of care. (Choose one) a) E&M b) Volume | c) Category Il d) Category Il Question 9 (5.00 Points) includes a monthly subscription and is secure, and patients have access to a database of health information. (Choose one) a) The patient portal b) The online personal health record c) The paper-based personal health record d) Personal health record software Question 10 (5.00 Points) Patients who want to have their health information in electronic format but don’t wish to store their private information online may prefer (Choose one) © 2023 PF High School, LLC Page: 15 of 20 © 2023 Career Step, LLC © 2023 Education Holdings 1, LLC © 2023 Sokanu Interactive
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Electronic Medical Records / Reimbursement and Personal Health Records a) personal health record software. b) patient portals. c) the online personal health record. d) the paper-based personal health record. Question 11 (5.00 Points) A server that provides data transfer and storage space at remote locations is known asa (Choose one) a) host. b) network. c) personal health record. d) patient portal. Question 12 (5.00 Points) A document that specifies which life-sustaining treatments (for example, mechanical ventilation and tube feeding) should be administered or withheld if the person becomes incapacitated is known as a/an (Choose one) a) authorization for the release of information. b) advanced directive. c) living will. d) medical power of attorney. Question 13 (5.00 Points) Part of the MU incentive program is the implementation of patient portals. These systems (Choose one) a) contain codes for office visits © 2023 PF High School, LLC Page: 16 of 20 © 2023 Career Step, LLC © 2023 Education Holdings 1, LLC © 2023 Sokanu Interactive
Electronic Medical Records / Reimbursement and Personal Health Records b) are tethered to the provider’'s EHR. c) are codes for services performed. d) are separate entities from the provider’'s EHR. Question 14 (5.00 Points) Which of the following is considered the second party? (Choose one) a) Patient b) Employer ¢) Insurance company d) Provider Question 15 (5.00 Points) Which of the following Category | codes are most heavily used? (Choose one) a) Evaluation and Management b) Anesthesia c) Pathology d) Laboratory Question 16 (5.00 Points) Which range of Category | code numbers includes orders for blood panel tests and procedures for a Pap smear? (Choose one) a) Anesthesia codes, 00100-01999 b) Radiology codes, 70000-79999 c) Pathology and Laboratory codes, 80000-89398 d) Medicine codes, 90281-99099 © 2023 PF High School, LLC © 2023 Career Step, LLC © 2023 Education Holdings 1, LLC © 2023 Sokanu Interactive Page: 17 0f 20
Electronic Medical Records / Reimbursement and Personal Health Records Question 17 (5.00 Points) is a misrepresentation of medical services provided for purposes of deceiving or misleading another person or entity. (Choose one) a) Medical identity theft b) Abuse c) Claim tracing d) Fraud Question 18 (5.00 Points) refers to the legal doctrine that holds medical services rendered as reasonable and necessary according to generally accepted clinical standards. (Choose one) a) Claim processing b) Patient ledger c) Superbill d) Medical necessity Question 19 (5.00 Points) A summary of all payments, charges, and adjustments to an account is called a (Choose one) a) superbill. b) patient statement. ¢) computerized provider order entry (CPOE). d) patient ledger. Question 20 (5.00 Points) © 2023 PF High School, LLC Page: 18 of 20 © 2023 Career Step, LLC © 2023 Education Holdings 1, LLC © 2023 Sokanu Interactive
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Electronic Medical Records / Reimbursement and Personal Health Records Who controls the PHR? (Choose one) a) The provider b) The insurance company c) The hospital d) The patient © 2023 PF High School, LLC © 2023 Career Step, LLC © 2023 Education Holdings 1, LLC © 2023 Sokanu Interactive Page: 19 0f 20
Electronic Medical Records / Reimbursement and Personal Health Records Lesson 3 Exam =D Open Link © 2023 PF High School, LLC © 2023 Career Step, LLC © 2023 Education Holdings 1, LLC © 2023 Sokanu Interactive Page: 20 of 20