Podcast
Questions and Answers
What is a New Patient?
What is a New Patient?
- A group of providers in a managed care organization
- A physician who transfers care of a patient to another physician
- A patient who has seen a provider within the past three years
- Someone who has not received any services from the provider in the past three years (correct)
What characterizes an Established Patient?
What characterizes an Established Patient?
- Provider who agrees to provide medical services to a payer
- Patient who has seen a provider within the past three years (correct)
- Someone who has not seen a provider in the past three years
- Provider that does not have a participation agreement with a plan
Who is a Referring Physician?
Who is a Referring Physician?
A physician who transfers care of a patient to another physician.
What is meant by the term 'Network'?
What is meant by the term 'Network'?
What is a Participating Provider (PAR)?
What is a Participating Provider (PAR)?
Define a Nonparticipating Provider (nonPAR).
Define a Nonparticipating Provider (nonPAR).
What does Out-of-Network refer to?
What does Out-of-Network refer to?
What is included in a Patient Information Form?
What is included in a Patient Information Form?
What does Insured refer to?
What does Insured refer to?
Who is referred to as the Subscriber?
Who is referred to as the Subscriber?
What is the role of a Guarantor?
What is the role of a Guarantor?
Define Social History in medical terms.
Define Social History in medical terms.
What do Medical History Forms ask for?
What do Medical History Forms ask for?
What is a Policyholder?
What is a Policyholder?
What are Insurance Cards used for?
What are Insurance Cards used for?
What does Assignment of Benefits mean?
What does Assignment of Benefits mean?
What is the purpose of an Acknowledgment of Receipt of Notice of Privacy Practices?
What is the purpose of an Acknowledgment of Receipt of Notice of Privacy Practices?
What is a Chart Number?
What is a Chart Number?
What is a Practice Management Program (PMP)?
What is a Practice Management Program (PMP)?
The steps for Patient Eligibility for Insurance Benefits include verifying eligibility, determining preauthorization and referral requirements, and ___?
The steps for Patient Eligibility for Insurance Benefits include verifying eligibility, determining preauthorization and referral requirements, and ___?
What requires contacting the payer for verification?
What requires contacting the payer for verification?
A Medical Emergency implies care is provided only after checking insurance.
A Medical Emergency implies care is provided only after checking insurance.
What are Factors Affecting Insurance Eligibility?
What are Factors Affecting Insurance Eligibility?
Study Notes
Patient Definitions
- New Patient: A person who has not received services from the provider or a similar specialty within the last three years.
- Established Patient: A patient who has seen the provider in the past three years.
Healthcare Providers
- Referring Physician: A doctor who transfers a patient's care to another physician.
- Participating Provider (PAR): A provider who agrees to deliver services to patients covered by a specific health plan under a contract.
- Nonparticipating Provider (nonPAR): A provider who does not join a specific health insurance plan.
- Out-of-Network Provider: A provider without a participation agreement with a health plan; patients without out-of-network benefits are fully responsible for costs.
Patient Information
- Patient Information Form: A form detailing personal, employment, and insurance data of patients.
- Insured: A person who holds a policy under a health plan.
- Subscriber: The individual who is insured under a health policy.
- Guarantor: The insurance policyholder accountable for the patient's medical expenses.
Patient History and Socioeconomic Factors
- Social History: Information regarding lifestyle choices, including smoking, exercise, and alcohol consumption.
- Medical History Forms: Forms that collect details on the patient's personal and family medical history, along with social history.
Insurance and Billing
- Policyholder: The individual who owns the insurance policy; this can be a patient or someone not receiving care from the practice.
- Insurance Cards: Essential documents that need to be accurately processed during patient registration to match information during claims.
- Assignment of Benefits: A directive for insurance benefits to be paid directly to a healthcare provider.
Privacy and Legal Forms
- Acknowledgment of Receipt of Notice of Privacy Practices: A form that indicates the patient has received privacy information; only direct care providers need a signed acknowledgment.
Administrative Processes
- Chart Number: A unique identifier for patients linking all related medical information.
- Practice Management Program (PMP): A database that tracks patients, insurers, and visits, requiring continuous updates.
- Patient Eligibility for Insurance Benefits: The process of determining a patient's financial responsibility includes verifying coverage, preauthorization needs, and identifying the primary insurer.
Verification and Emergencies
- Contacting the Payer for Verification: A procedure to confirm a patient's eligibility, required payments, and covered services for an encounter.
- Medical Emergency: Immediate care provided, with insurance status verified post-encounter.
Insurance Eligibility Considerations
- Factors Affecting Insurance Eligibility: Timely premium payments are necessary to maintain coverage, especially for government-sponsored plans.
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Description
This quiz focuses on key terms related to patient encounters and billing information, providing definitions for essential healthcare concepts. Understand the difference between new and established patients, as well as the role of a referring physician. Perfect for students in healthcare administration or medical billing courses.
