Billing
The length of time from the date of service in which a health care organization may submit a claim to the third-party payer.
timely filing
Schedule two or three patients during a designated hourly time period (last 30 minutes of the hour, patients seen in order of arrival).
Wave scheduling
New patient
60 min
UCR fee: $300
Insurance allowed fee: $250
Coinsurance: 20%
Cost of procedure for pt?
$50
COB
Coordination of benefits
A reimbursement model intended to improve the traditional fee-for-service method by changing the focus to value-based care rather than volume-based care.
pay-for-performance (P4P)
A period of time between appointments.
interval
Urgent
20 min
UCR fee: $350
Insurance allowed fee: $250
Coinsurance: 20%
Amount of adjustment?
$100
AVS
After Visit Summary
Rewards the provider with incentive payments for meeting defined program performance standards.
value-based care model
A ________ is the designed timeframe for appointments based on the method of appointment durations.
matrix
Established/follow-up
15 min
UCR fee: $350
Insurance allowed fee: $250
Coinsurance: 30%
Cost of procedure to pt?
$75
ABN
Advanced Beneficiary Notice
A managed care method of monthly payments to the provider based on the number of enrolled patients, regardless of how many encounters a patient may have during the month.
Capitation
Keep in mind ________ patients are a priority for the overall patient health and safety and to aid in any future potential legal oversights.
urgent
Other entities
30 min
UCR fee: $350
Insurance allowed fee: $250
Copayment: $25
How much does insurance pay?
$225
EEG
electroencephalogram
A response from the payer of claims payment and an explanation of patient responsibility amounts and any adjustments made to the billed amount by the payer.
remittance advice
What communication barrier might need additional arrangements when scheduling a new patient?
Speaks a different language than the provider
Complete annual physical exam
60 min
UCR fee: $500
Insurance allowed fee: $450
Coinsurance: 20%
How much does insurance pay?
$360
CVA
cerebrovascular accident