Patient Access
This department is responsible for scheduling, registration, and verifying insurance before a patient receives care.
Patient Access
These codes are used to describe diagnoses in medical billing.
Whata re ICD-10 Codes
This is the process of submitting bills to insurance companies.
What is claims submission?
This process ensures that all services provided to a patient are documented and billed.
What is charge capture?
This occurs when a payer refuses to reimburse a claim.
What is a denial?
This process ensures that a patient’s insurance will cover the services before they are provided.
These codes represent procedures and services provided to patients.
What are CPT codes?
This term refers to the amount the hospital expects to collect from payers and patients.
What is net revenue?
This type of documentation is essential for accurate charge capture.
What is clinical documentation?
This type of denial results from missing or incorrect patient information.
What is a front-end denial?
This term refers to the amount a patient must pay before insurance begins to cover costs.
What is a deductible?
This department translates clinical documentation into billable codes.
What is the coding department
This report shows which claims have been paid, denied, or are pending.
What is an Aged Trial Balance (ATB)
This system helps providers enter charges directly into the electronic health record
What is computerized provider order entry (CPOE)?
This team works to appeal denied claims and recover lost revenue.
What is the denials management team?
This form is signed by patients to acknowledge their financial responsibility.
This type of coding error can lead to claim denials or audits.
What is upcoding or miscoding?
This team follows up on unpaid claims and appeals denials.
What is the accounts receivable or collections team?
This audit identifies missed or incorrect charges.
What is a charge reconciliation audit?
This tool helps track denial trends and root causes.
What is a denials dashboard or analytics tool?
What is a financial consent form?
This software checks claims for errors before submission to payers.
What is claims scrubber?
This metric measures how long it takes to collect payment after a service is rendered.
What is Days in Accounts Receivable (A/R)?
This role often reviews clinical records to ensure all billable services are captured.
What is a charge capture analyst or revenue integrity specialist?
This strategy involves proactively preventing denials through process improvement.
What is denial prevention or denial mitigation?