Payment Reconciliation
This is what we call the total paid amount, plus any patient responsibility, and sequestration (if a it's a Medicare Advantage account).
What is "the total Allowed Amount"?
This is the auto adjustment that is used to reflect the difference between total charges and our expected reimbursement.
What is a "Contractual Adjustment"?
This code is placed on an account to identify specific payer issues, track trends and for escalation purposes...
What is "a UFC code"?
This is an EOB with a virtual credit card attached sent in as payment from some insurance companies...
What is "a Quick Remit"?
This reimbursement rate is a fixed amount for each day the patient is in-house.
What is "Per diem"?
This is an additional 2% reduction applied to the paid amount on Medicare and Medicare advantage claims.
What is "Sequestration"?
Adjustments that use a "W" T-Code are this kind of adjustment...
What is a "Write Off"?
There are this many levels of UFC codes...
What is "6"?
These EOBs do not have any payment attached and they have code that identify why charges were not covered...
What is a "Denial/Zero Pay"?
This determines the patients level of care.
What is the "Accommodation Code"?
We are not allowed to bill Medicare and Medicare Advantage patients for copays, coinsurance or deductibles if they are this...
What is "QMB Eligible"?
Placing brackets around the adjustment amount indicates this...
What is "you are increasing the balance by this amount"?
This Level 2 UFC is used for a coordination of benefits issue...
What is "COBI"?
This portal is used for Payment Move Forms, Posting Errors or corrections on payments needed, Missing payments (only when insurance states payments were cashed...
What is "Cash Review"?
This is the name of the insurance code we use to locate the reimbursement information on the contract grid tool.
What is the "Insurance Plan Code"?
This is the tool used to check the contracted rates for a specific payers.
What is the "Contract Grid Tool"?
This is the billing period (BP) date utilized in an adjustment request.
What is "billing period end date"?
This level 3 UFC code is used when a facility update is needed...
What is "FUND"?
Allow this many business days for corrections to be made before placing a request for a posting error...
What is "3 business days"?
This reimbursement rate is based on the CMS pricer.
What is "CMG rate"?
This is the tab you would need to use in Millenium to review a patients QMB eligibility.
What is "The Insurance tab"?
An adjustment request for an amount over $10,000.00 requires this many levels of approval...
What is "3"? (Manager, CFO & CEO)
When accounts need additional assistance from the facility or to notify it of any account issues that may have a a high financial impact, Their information is added here...
What is "the Action Item Log"?
Adjustment corrections will be made only if the error was made by this team...
What is "the Cash Team"?
This is the clause listed in the contract advising that the estimated reimbursement will depend on if the billed charges are more or less another contracted rate.
What is the "Less of Clause"?