Revenue Cycle Flow
This is the first status of the HB HAR during admission or preadmission
What is Open?
During admission, staff collect this information to begin the billing process.
What are patient demographics and insurance information?
These codes explain why the patient came in.
What are ICD-10-CM diagnosis codes?
This third-party entity acts as the middleman between providers and insurance companies.
What is a clearinghouse?
Hospital Billing is required for services in these licensed institutions.
What are Article 28 facilities?
After discharge, the account enters this status before a claim is created.
What is DNB (Discharged, Not Billed)?
Insurance should be reverified in Epic every this many days.
What is 30 days?
These inpatient procedure codes describe what was done during the hospital stay.
What are ICD-10-PCS codes?
If a claim has errors at initiate billing, it is returned with this status.
What is rejected?
This New York surcharge is a 9.63% tax on hospital services.
What is the HCRA surcharge?
This step occurs after discharge and before claims are sent to insurance.
What is Initiate Billing?
A written order from a PCP for a specialist or medical service is called this.
What is a referral?
These tell what kind of service was provided and where it happened, such as OR, ER, or lab.
What are revenue codes?
Insurance carriers perform this process when deciding whether to pay in part, in full, or deny.
What is adjudication?
These individuals are exempt from the HCRA surcharge.
Who are embassy employees and diplomats?
This is the final HB HAR status once all balances are paid.
What is Closed?
For an outpatient knee arthroscopy requiring prior authorization, this team gets the authorization for the hospital
What is the hospital scheduling or utilization review team?
These group services and help determine how payment is calculated.
What are DRG/APC?
This document comes with payment or denial from the insurance carrier.
What is remittance advice or an Explanation of Benefits (EOB)?
Medicare has this many parts.
What is four?
Put these hospital revenue cycle steps in order: Insurance Payment, Discharge, Claims Sent, Admission/Preadmission, Detailed Bill Sent, Initiate Billing, Guarantor Payment.
What is Admission/Preadmission → Discharge → Initiate Billing → Claims Sent → Insurance Payment → Detailed Bill Sent → Guarantor Payment?
In an inpatient admission from the ER, missing this payer timeframe can result in denial of the entire stay.
What is the retrospective authorization/notification timeframe, usually within 24–72 hours?
Hospital facility charges are billed on this form, while physician services are billed on the CMS-1500.
What is the UB-04?
On a UB-04, this 3-digit code identifies facility type, service type, and billing frequency.
What is the Type of Bill (TOB)?
As of 01/01/2026, this plan replaced BCBS GHI Composite for NYC employees.
What is the New York City Employees PPO (NYCE PPO) plan?