NATIONAL CERTIFICATION

Transcription

1 NCCA: Examinatin Cntent Medical Administrative Assistant / Office Specialist Exam Cntent Outline Dmain Areas: (I) (II) (III) (IV) (V) (VI) (VII) (VIII) Paper & Electrnic Medical Recrds Medical Cding Medical Billing & Prcessing Claims Insurance Healthcare Laws & Regulatins Appintments & Scheduling Cmmunicatin Financial management & ffice supplies DOMAIN AREAS CHECK Dmain I : Paper & Electrnic Medical Recrds Clinical Recrds & Medical Dcument Medical Charts Filing the Chart Medical Dcumentatin Rules SOAP Ntes Signature Cards Retentin f Recrds String Medical Recrds Electrnic Medical Charting Cmputerized Files Recrd Transfers Patient Infrmatin Sheet 1

2 NCCA: Examinatin Cntent Release f Infrmatin Frm Assignment f Benefits Frm Patient Histry Frm Medical Abbreviatins & Terminlgy Fllwing Electrnic Health Recrd Standards The Clinic Administratin The Patient's Chart Transitining t an Electrnic Health Recrd Implementatin f EHR Harmful Events Medical Errrs Cnversin f Data Paper vs Electrnic Health Recrds Prtected Health Infrmatin Persnal Health Recrds Dcument Scanning Dcument Printing Dcument Fax Dcument Mailing Dcument Appearance, Timeliness & Accuracy Dcument Crrecting, Amendments, Deletins & Retractin Plicy Release f Medical Recrd Understanding f Patient Bills f Rights 2

3 NCCA: Examinatin Cntent Dmain II :Medical Cding ICD-9-CM, Determining & Assigning CPT, Determining & Assigning HCPCS Level II Cdes, Determining & Assigning Internatinal Classificatin f Disease (ICD-9-CM) Cding Hw t Use the ICD-9-CM Index & Tabular List General Guidelines Main Terms V Cdes E Cdes Signs and Symbls Used in the ICD-9-CM Current Prcedural Terminlgy (CPT) Cding Using the CPT Semiclns in the CPT Signs and Symbls Used in the CPT CPT Index CPT Mdifiers CPT Categry I a) Evaluatin and Management Cdes Sectin b) Anesthesia Sectin 3

4 NCCA: Examinatin Cntent c) Surgery Sectin d) Radilgy/X-ray Sectin e) Pathlgy/Labratry Sectin f) Medicine Sectin CPT Categry II a) Perfrmance Measurements CPT Categry III a) Emerging Technlgy Dmain III :Medical Billing & Prcessing Claims Claim Audits Delinquent Claims Medical Practice Accunting Patient Accunting Accunts Payable/Receivable Patient Ledger Card/Statement f Accunt Insurance Payments Patient Payments Psting Payments Balance Billing Fllw-Ups Cllectins 4

5 NCCA: Examinatin Cntent Cllectins Prcedures Small Claims Curt Practice Accunting Petty Cash The Day Sheet/Daily Jurnal Office Reprts CMS-1500 Frm and Medical Billing Prcedures Superbill CMS-1500 Frm Patient Claim Frm Billing fr Services Determining the Prper Billing Amunt Special Services Claims Submissin Prcess Clean Claims Crdinatin f Benefits Health Maintenance Organizatins Cllecting the Patient Prtin Billing Reprts Prmpt Payment Laws Tracer Claims/Delinquent Claims Denied Claims Resubmissin f Claims 5

6 NCCA: Examinatin Cntent Adjusted Claims Review and Appeals Balance Billing Patients fr Dwn-cded r Denied Claims The UB-92 Frm and Hspital Billing Prcedures Unifrm Bill (UB-04) Assignment f Benefits Charge master & Superbill Descriptins Entering Charges Preauthrizatin, Precertificatin and Utilizatin Reviews Patient Infrmatin Sheet Insurance Cverage Frm Patient Claim Frm Superbill/Charge Slip Insurance Claim Register Aging reprt Remainder statement Standard statement Face sheet Infrmed cnsent Incident reprt Day sheet 6

7 NCCA: Examinatin Cntent Dmain IV :Insurance Insurance Verificatin / Preauthrizatin Pre-Authrizatin Prcess Request Frms Tricare, Blue Crss/ Blue Shield Tricare Plan, Blue Crss/ Blue Shield Plan Tricare Claim, Blue Crss/ Blue Shield Claims Cmmercial Insurance Cmmercial Insurance Plan Cmmercial Insurance Claim Medicare and Medicaid Medicare Medicare Eligibility The Parts f Medicare Allwable Charges Medicare Physician Identificatin Numbers Medicare Billing Ntices 7

8 NCCA: Examinatin Cntent Assignment f Benefits Medicare Secndary Payer Durable Medical Equipment Medicare Denials Advance Beneficiary Ntice (ABN) The Medicare Appeals Prcess Medicare Fraud and Abuse Medicare Supplemental Insurance Medicare and Managed Care Medicare Ntice f Nn-Cverage Medicare Billing Guidelines Medicaid Medicaid Cvered Services Reimbursement frm Medicaid Medicaid as Secndary Payer Treatment Authrizatin Request Wrkers' Cmpensatin Fraud and Abuse Types f Wrkers' Cmpensatin Benefits Patient Recrds Dctr's First Reprt f Injury/Illness Prgress Reprts 8

9 NCCA: Examinatin Cntent Wrkers' Cmpensatin Appeals Office Administratin Dmain V :Healthcare Laws & Regulatins HIPAA Security rule Privacy rule Administrative simplificatin prcess Cvered entities HIPAA TITILE Title 1 Title 2 Title 3 Title 4 Title 5 Medical Law & Ethics Legal Issues In Healthcare Fraud Negligence Malpractice Battery Infrmed Cnsent 9

10 NCCA: Examinatin Cntent Trt Libel Slander Defamatin Assault Duty f care Standard f care Liability Dmain VI :Appintment & Scheduling Creating an appintment Scheduling an appintment Organizing Appintments Cnfirming & Reminder Appintment Calls Electrnic Scheduling Dmain VII :Cmmunicatin Cmmunicatin with patient Cmmunicatin with cwrkers Custmer Service Patient Receptin Dmain VIII :Financial management & ffice supplies Medical Office Supplies 1 0

11 NCCA: Examinatin Cntent Maintaining Office Equipments Managing & Ordering Supply Inventry Recycling Office Supplies and Medical Waste Fr mre infrmatin r Visit 1 1