NCMOA flashcards

32 cards. Read the term and the definition here. The deck at the top of this page is optional.

Fixed-interval scheduling

A scheduling method in which every appointment is assigned the same length regardless of visit type, simplifying template design but reducing flexibility for complex or brief visits.

Modified-wave scheduling

A hybrid scheduling method where patients arrive in staggered waves, and short and long visits are mixed so that providers are not idle while long visits are in progress.

Recall system

A tickler file or EHR flag that identifies patients due for routine follow-up at a defined interval, such as a six-month hygiene visit or annual wellness exam.

No-show policy

A written rule stating the notice required to cancel and any fee applied for missed appointments, disclosed to patients in advance and enforced only within legal and contractual limits.

Waitlist backfill

The process of offering a newly opened appointment slot to waiting patients in priority order, using recorded availability windows to fill the opening efficiently.

Closed-loop referral

A referral process that documents the request, confirms the specialist received it, and requires a report back to the referring provider so care is not lost.

Read-back

A communication safety practice in which the receiver repeats a verbal or telephone order or critical result back to the sender for confirmation before acting on it.

Teach-back method

A communication technique where the patient explains instructions in their own words, allowing staff to confirm understanding and correct misunderstandings before the patient leaves.

Qualified interpreter

A trained interpreter with demonstrated proficiency in medical terminology, used instead of family members for consent discussions and other clinically significant communication with limited-English-proficiency patients.

Call reference number

An identifier issued by a payer during a phone inquiry, recorded with the representative's name and date so the conversation can be verified if a dispute arises later.

Addendum correction

A method of amending a medical record by adding a dated, signed note that explains the correction, leaving the original entry intact and readable.

SOAP note

A problem-oriented documentation format organized into Subjective, Objective, Assessment, and Plan sections, widely used for progress notes in ambulatory and hospital settings.

Legal health record

The data an organization designates as its official business record of care, distinct from secondary databases, shadow charts, and administrative files.

Record retention schedule

A policy specifying how long records are kept, set by state law and payer contracts, with longer periods often required for minors and for certain clinical categories.

Patient amendment request

A HIPAA right allowing patients to request changes to their record; the provider must respond in writing within the required timeframe, either accepting the change or explaining the denial.

Late entry

A documentation entry added after the fact, labeled with the actual date and time of writing plus a reference to the original event, rather than backdated to appear contemporaneous.

Copay vs. coinsurance

A copay is a fixed dollar amount per service; coinsurance is a percentage of the allowed amount the patient pays after the deductible is met.

Allowed amount

The contracted fee a payer recognizes for a service; for in-network claims, payer payment plus patient responsibility should equal this amount.

Clean-claim rate

The percentage of claims accepted on first submission without edits or rejections, a key indicator of front-end registration and coding accuracy.

Days in A/R formula

Days in accounts receivable equals total accounts receivable divided by total charges, multiplied by the number of days in the period; lower values indicate faster collection.

Modifier -25

A CPT modifier appended to an evaluation and management code when a significant, separately identifiable E/M service is performed on the same day as a procedure, supported by documentation.

Medical necessity linkage

The requirement that the ICD-10-CM diagnosis code on a claim support the reason the CPT procedure or service was performed, as documented in the record.

Minimum necessary standard

A HIPAA Privacy Rule requirement limiting PHI used or disclosed to the amount reasonably needed for the intended purpose, with exceptions such as treatment disclosures.

Breach notification deadline

Affected individuals must be notified without unreasonable delay and no later than 60 days after discovery of a breach of unsecured protected health information.

HIPAA right of access

Patients may obtain copies of their records within 30 days, extendable once by 30 days, for a reasonable cost-based fee that excludes search and retrieval charges.

Security risk analysis

A required HIPAA administrative safeguard in which the organization assesses threats and vulnerabilities to electronic PHI and documents a plan to reduce identified risks.

CLIA waived test

A laboratory test classified as simple with low risk of erroneous results, subject to the fewest CLIA requirements and usable in settings holding a certificate of waiver.

Stark Law

A federal prohibition on physician self-referral for designated health services paid by Medicare when a financial relationship exists, unless a specific exception applies.

Coordination of benefits

The process of determining which health plan pays first when a patient has multiple coverages; the birthday rule commonly governs dependent children with parents in separate plans.

Prior authorization

Advance payer approval required for certain services or drugs before they are rendered; services performed without required authorization may be denied or paid at reduced rates.

Explanation of Benefits

A patient-facing statement showing services billed, allowed amount, amount paid by the plan, and the patient's remaining responsibility for a claim.

CO-16 denial

A claim adjustment reason code indicating the claim or service lacks information needed for adjudication, such as a missing modifier, diagnosis, or authorization number.