Med Office Procedures

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Med Office Procedures
2013-02-13 10:14:24
Ministry health billing privacy act

Chapter 11 - 14
Show Answers:

  1. The ministry of health:
    Accepts claims, approves claims, monitors claims, investigates claims.
  2. Prior Approval:
    Certain procedures require prior approval.
  3. Verification Letters/Service/Audits:
    Sent to random clients for verification.
  4. A billing number consists of:
    Group registration number, providers registration number, specialty code.
  5. Specialty codes
    A code that specifies what specialties the physician has.
  6. Diagnostic Codes
    Represents the diagnosis a client received
  7. How many characters does a billing code consist of?
    5 characters
  8. A billing code consists of:
    Prefix, Numberic Component, Suffix
  9. Consultation
    conversing with another professional
  10. Repeat Consultation
    Physician converses once again about what to do about a problem
  11. Limited Consultation
    If a doctor wants an opinion on a small thing, usually quick
  12. General Assessment/Complete Examination
    Check-up, everything is billed separately
  13. General Re-assessment
    "Take 2 tylenol and call me in the morning"
  14. Preoperative/Pre-dental General Assessment
    They will make sure vitals are good so you are stable before surgery.
  15. Telehealth Services
    If a doctor has to travel far to see you.
  16. House Call Assessment
    Doctors going to visit patients at homes.
  17. House Call Assessment - Pronouncement of Death
    A coroner comes to pronounce the person dead.
  18. Pronouncement of Death - Intermediate Assessment
    When they don't expect to pronounce someone dead; anywhere except home and hospital.
  19. Intermediate or Regional Assessment/Limited Visit
    "I think my kid has lice" - "Yes, he has lice."
  20. Well Baby Visits
    There are certain things by law in which the doctor must discuss with you.
  21. Annual Health/Physical Exam (child)
    On their 3rd visit/year
  22. Parental Visit - Initial Assessment
    Asked a lot of questions to know what the baby will be like.
  23. Routine Parental Visits
    Very quick, measures stomach
  24. AntenatalPreventativeHealth Assessment
    Decidingto have your first child
  25. Counseling
    Talking, billed each 15 minutes with a max of 2 hours, but extra billing codes may be added
  26. Rejection Codes
    Indicates a range of reasons why the claim  has been rejected.
  27. Billing Cards
    Fewer than 1% use this
  28. Machien readable input/output
    Info that can be read by a computer
  29. Tape Cartrige / disc
    Must be physically couriered to sites, time consuming.
  30. Electronic Transfer
    Similar to email
  31. Claim deadlines in Ontario are:
    At the end of each month
  32. First step of preparing a claim:
    Client Registration
  33. Software Billing Options:
    Day Sheet (spreadsheet of patients), Billing (software that submits for you), Electronic Records (paperless system)
  34. HCP Claim
    Typical claims within your province/territory
  35. RMB
    Out of province patients
  36. WCB/WSIB
    Also billed to the ministry
  37. eHealth
    Describes electronic health information
  38. Canada Health Infoway
    A government funded organization focused on developing electronic health records
  39. Health Information
    Any information pertaining to an individual's physical or mental health
  40. Health Information Custodian
    Person responsible for managing health information
  41. Continuity of Care
    Knowing a client's medical history, treatments, allergies, etc.
  42. Electronic Medical Record
    Legal health record in digital format
  43. Electronic Health Record
    Accumulation of essential information from an individual's EMR
  44. Mandatory Reporting
    Reportable diseases, suspected abuse in children, etc.
  45. Minor Clients
    Up to physician to decide what he shares with a minor and parents
  46. The Privacy Act
    Within federal government, rules & policies, individuals have the right to any information they have about them
  47. Personal Information Protection and Electronic Documents Act (PIPEDA)
    Shows how organizations within the private sector and collect, use and disclose personal information
  48. 10 Principles of PIPEDA:
    • 1. Accountability - Privacy Information Officer
    • 2. Identifying Purposes - must inform clients
    • 3. Consent - must be obtained
    • 4. Limiting Collection of Personal Info: a link between why and what we collect must be present
    • 5. Limiting Use, Disclosure and Retention: Only use what is needed and destroy what is not.
    • 6. Accuracy: info should be accurate
    • 7. Safeguards: must ensure info is safe
    • 8. Openness: policies are available to clients
    • 9. Individual Access: client has right to access their info
    • 10. Challenging Compliance: process to handle complaints
  49. Paper charts must be kept in Ontario for ___ years.
  50. Records of minors must be kept until ___ years after they reach age of majority.