In other words
EOB
Remittance
EOP
EFT
What is the name of the system that drops our accounts down to expected reimbursement?
Contract Management
True or False
Pre-authorization is always required for emergency services
False. Emergency services are typically covered without prior authorization.
What is a mandatory step following an update?
Scan elig
Check acct next day
update in both systems
INVP/28R/ETC
What dept does Christopher Ridente work in?
Revenue Cycle
Patient financial service
Medical billing cycle
revenue management
Accounts receivable
At what age is a child dropped from their parents insurances?
26
True or False
Payers always reimburse facility claims based on the submitted charges.
False. Reimbursement is often based on contracted rates, DRGs, APCs, or fee schedules—not just submitted charges.
Where can you locate authorizations?
PM office, Powerchart, Rasi, RC9U, payer portals, etc
What departments are Thomas Insinna responsible for?
Analyst and Variance
Authorization
Preapproval
Prior approval
Prior AUTH
utilization review
What is claim scrubber?
Billing system designed to catch error and implement edits for insurances based on contracts/policies/etc.
True or False
Facility billing uses CPT codes exclusively for all services rendered.
False. Facility billing uses both CPT/HCPCS codes and revenue codes, depending on the service and setting.
Name one thing that is required on an RIRV no auth note
clm #, cpt, denial reason, $ amount, etc
Who is the coordinator for cash posting?
Leonor Afre
Patient responsibility
Out-of-pocket cost
cost share
patient balance
copay
coinsurance
deductible
How many DX codes are currently in use?
Closest guess
69,832 active ICD-10-CM diagnosis codes
True or False
A “clean claim” is one that is submitted without errors and can be processed without additional information.
True.
What does LMS stand for?
Learning Management Systems
Who is the Aetna JOC lead?
Tammi
Your awesome supervisor
The GOAT
Rockstar boss
Chief of awesome
Captain of the Cubicle Ship
The Boss father
The Chaos Coordinator
The Sultan of Supervision
Your Manager of Mayhem
Your Supervisor of Sass and Success
What CDM stand for?
Charge Description master
True or False
There’s an ICD-10 code for “struck by a turtle”
TRUE (W59.22XA)
What are the time increments you can use when documenting time off in Kronos based on UUP?
1.88
3.75
5.62
Who is the analyst in charge of the BX JOC ss?
Jorge