Eligibility Essentials
This must be verified before services to ensure proper billing and reimbursement.
What is insurance eligibility?
This revenue code is commonly used for hemodialysis treatments.
What is 0821?
This Massachusetts location once served as the main corporate office site for the organization.
What is Cummings Center in Beverly, MA?
This occurs when a payer takes back money from a previously paid claim.
What is a recoupment?
This is the first step after identifying a denied claim.
What is claim review?
When a patient has both Medicare and a commercial plan, this determines which pays first.
What is coordination of benefits (COB)?
This modifier is used to report the amount of a drug that is discarded and not administered to the patient.
What is modifier JW?
This company was acquired by Innovative Renal Care in 2021.
What is American Renal Associates?
This term refers to the difference between billed charges and allowed amounts.
What is a contractual adjustment?
This common dialysis denial occurs when authorization is missing.
What is no authorization denial?
This Medicare period covers ESRD patients and impacts when Medicare becomes primary.
What is the 30-month coordination period?
Incomplete or incorrect documentation of this can lead to billing delays for dialysis treatments.
What is treatment documentation (or treatment notes)?
This team at IRC is responsible for resolving credit balances, including refunds, and recoupments.
What is Credit Resolution?
This is created when a payment is applied incorrectly and results in a credit balance.
What is an overpayment?
This limit determines how long you have to resubmit or appeal a denied claim.
What is a timely filing limit?
Who is the Revenue Cycle Manager overseeing the Eligibility Team?
Who is Alexandria "Ali" Hoerzer?
This billing requirement ensures all dialysis-related services are included in one comprehensive rate.
What is bundled payment (ESRD PPS)?
Before becoming CEO in February 2025, David Doerr held this executive role at IRC.
What is Chief Operating Officer (COO)?
Failing to correctly post this can lead to inaccurate AR and reporting.
What is a zero-payment (or $0) adjustment?
This type of denial indicates another payer should have been billed first.
What is coordination of benefits (COB) denial?
This type of insurance requires ongoing review to confirm continued coverage for dialysis patients.
What is Medicaid eligibility?
Incorrect use of this leads to claims being processed at $0 or recoupments later.
What is an incorrect HCPCS/CPT code?
This clinic was opened by American Renal Associates in 2000 - and is still operating today!
What is Butler County Dialysis Center?
This action is required to return funds when a payer requests money back and you agree.
What is a refund?
When multiple accounts show the same underpayment trend despite correct billing, it often signals this upstream issue.
What is a contract or payer configuration issue?