Administrative Practice and the Revenue Cycle
What to know
Administrative content covers appointment scheduling, patient registration, medical records, release of information, HIPAA privacy and security, insurance terminology, billing and coding basics, bookkeeping, supplies, and office communication. Master the revenue cycle: registration, verification of eligibility and benefits, coding, claim submission, payer adjudication, patient responsibility, and collections. Know the difference between copayment (fixed amount at service), coinsurance (percentage of allowed amount), and deductible (amount paid before insurance begins). Understand explanation of benefits, remittance advice, the CMS-1500 claim form, and how to handle subpoenas, court orders, and requests for records. Know scheduling priorities: urgent same-day visits, follow-up intervals, buffer slots, and no-show policies.
Traps
Questions confuse copay with coinsurance, or ask who owns the medical record (the provider or facility, not the patient). A release must be specific, time-limited, and signed; a subpoena may still require verification. Do not assume a caller is authorized just because they give a name. Another trap is calculating patient balance from the charged amount instead of the allowed amount.
Worked example
Allowed amount $120; unmet deductible $50; coinsurance 20%. Patient pays $50 plus 20% of the remaining $70, which is $50 + $14 = $64; insurance pays $56. Rule of thumb: patient responsibility = unmet deductible + coinsurance percentage × (allowed amount − deductible paid), plus any fixed copay if the plan uses one.