Questions and Answers
What does Assignment of Benefits authorize?
The physician to file claims for a patient and receive direct payments from the payer.
What type of use of PHI would a practice use to discuss a patient's case with another provider?
What provision explains how insurance policies will pay if more than one policy applies?
Coordination of benefits
In what order are benefits typically determined when parents do not have joint custody?
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In what format does an encounter form come?
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When should additional coverage be reported to the primary payer under a coordination of benefits provision?
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Which HIPAA transaction is used to check patient's insurance coverage?
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What information is gathered via the patient information form?
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What does a patient's insurance card usually show?
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What means are available for completing an encounter form?
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How is a new patient defined?
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What rule applies for a child's primary coverage when both parents have coverage?
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What is another name for the HIPAA Eligibility for a Health Plan transaction?
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What type of use of PHI is for staff training and quality improvements?
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How should the financial policy be presented to ensure that all patients can follow it?
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Which of these documents will the patient not complete?
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What does an Acknowledgment of Receipt of Notice of Privacy Practices state?
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Study Notes
Assignment of Benefits
- Authorizes physicians to file claims for patients and receive direct payments from payers.
Use of PHI
- Treatment involves discussing a patient’s case with other healthcare providers.
- Health care operations involve training staff to enhance healthcare quality.
Coordination of Benefits
- Provision outlines payment methods when multiple insurance policies apply.
- Benefits for children determined by:
- Custodial parent's plan
- Spouse of custodial parent's plan (if applicable)
- Non-custodial parent's plan
Encounter Form
- Available in paper and electronic formats.
- Can be completed using laptops, tablets, or paper forms.
Insurance Coverage
- The HIPAA Eligibility for a Health Plan transaction checks patient insurance coverage.
- Also referred to as X12 270/271.
Patient Information Form
- Gathers personal and insurance information from patients.
- Does not include patient's previous employer or first payment date on insurance card.
New Patient Definition
- Defined as one who has not seen the provider in the past three years.
Coverage Coordination Rules
- Gender rule: child’s primary coverage goes through the father’s plan when both parents have policies.
Financial Policy Disclosure
- Must be displayed in the reception area or included in new patient information packets to ensure transparency.
Patient Document Completion
- Patients are typically not required to complete the encounter form.
- Common forms include assignment of benefits, medical history, and patient information forms.
Acknowledgment of Privacy Practices
- Indicates patients understand how their privacy rights are protected under HIPAA.
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Test your knowledge with these flashcards covering key terms in healthcare from Chapter 3. Each card will help you understand important concepts such as assignment of benefits and the use of PHI in treatment. Perfect for students and professionals in healthcare.
