CRC final exam study guide Latest 2023 Graded A+, Exams of Nursing

Download CRC final exam study guide Latest 2023 Graded A+ and more Exams Nursing in PDF only on Docsity! CRC final exam study guide Latest 2023 Graded A+ Health record (Medical Record) - correct answer ✅Written or graphic information documenting the facts and events during the rendering of patient care. SOAP notes - correct answer ✅Office visit notes organized into four sections: Subjective, Objective, Assessment, Plan EMR - correct answer ✅An electronic file wherein patients health information from a single medical provider is stored in a computer system EHR - correct answer ✅A computerized lifelong healthcare record for and individual that incorporates data from all providers who treat the individual. EHR advantages - correct answer ✅Accessibility between providers improves quality of care; Cost savings and increased efficiency; Requires no physical storage; Reduced charting errors; Automatic data capture Attending physician - correct answer ✅Hospital staff member who is legally responsible for care and treatment given to a patient CRC final exam study guide Latest 2023 Graded A+ Legible documentation requirement - correct answer ✅Info in the health record must be easily recognizable by someone outside of the medical practice who is unfamiliar with the handwriting. Internal Audits - correct answer ✅Audits performed by a staff member of the practice or by a hired consultant to uncover problems in coding and billing compliance so they can be corrected. Prospective Review - correct answer ✅Review of billing and coding completed BEFORE claims are submitted. Retrospective Review - correct answer ✅Internal review of billing and coding completed AFTER claims are submitted and after ins co has responded. Compliance Plan - correct answer ✅A medical practice's written policies for complying with payer and government regulations in order to avoid fraud and abuse. Collections Specialist - correct answer ✅Staff member trained to work with patients to resolve overdue bills. CRC final exam study guide Latest 2023 Graded A+ Denied claims - correct answer ✅Clean claims that the insurance company has determined are not eligible for payment. Determination - correct answer ✅An insurance company's decision of whether to approve (pay), deny, or downcode each service billed on the claim. Remittance advice - correct answer ✅Document sent to the provider by the insurance company explaining claim determination. Prompt payment laws - correct answer ✅State laws that outline how long the payer has to respond to a clean claim. 30 days electronic claims 40 days paper claims - correct answer ✅Health insurance claims prompt payment timeframe per NJ Department of Banking and Insurance Accounts receivable (A/R) - correct answer ✅The department responsible for managing and monitoring account balances owed to the practice. CRC final exam study guide Latest 2023 Graded A+ Insurance aging report - correct answer ✅Report of all balances owed to the practice by insurance companies, sorted by the length of time the money has been outstanding. Claim status inquiry - correct answer ✅Contacting the insurance company by phone, web portal, or mail to request an update on the status of an outstanding claim. Appeal - correct answer ✅A reconsideration request used to challenge a payer's denial. EDI - correct answer ✅The exchange of data through computer systems (for example, health insurance claims are exchanged between healthcare providers and insurance carriers). Clearinghouse - correct answer ✅Organization that receives batches of electronic claims from the health care provider, translates the claims to standard format, checks for errors, and forwards claims to the appropriate insurance companies. ASC X12N 837P (837P) - correct answer ✅Electronic health care claim for professional providers (replaces the paper CMS-1500). CRC final exam study guide Latest 2023 Graded A+ CMS-1500 [02/12] - correct answer ✅The current version of the standard paper claim form used by professional healthcare providers and suppliers to bill insurance carriers. NUCC - correct answer ✅Organization responsible for the creation and maintenance of the 1500 claim form and its instruction manual. Members include the AMA, CMS, and other healthcare stakeholders. Clean claim - correct answer ✅A claim that is submitted within the proper time frame and containing all necessary information so that it can be processed. Dirty Claim - correct answer ✅Claim submitted with missing information, errors, or one requiring manual processing to resolve problems or questions. Paper claim form completion guidelines - correct answer ✅Use original forms printed in red ink. Computer-generate or type all info in black ink. Align the printer correctly to keep characters within the borders of each field. Use 10-pt PICA or 10, 11, 12 pt Arial Font. Don't use strikeover or whiteout for mistakes. Don't handwrite or highlight anything on the claim form (except signatures).