Terminology
These codes indicate the conditions or symptoms a patient is experiencing at time of visit
Diagnosis codes or ICD-10s
This claim form is used by professional providers.
CMS 1500
Workit was founded in this year
2015
This federal law enacted in 1996 set national standards for protecting the confidentiality and security of patient health information.
Health Insurance Portability and Accountability Act
These two benefits should be checked for care at Workit
Substance Abuse and Telehealth
This document is sent to the provider to provide payment or denial details. It's often used synonymously with another term.
Remittance Advice
Marking a claim with this number will indicate it is a corrected claim
7
Workit was originally founded by these two women
Robin McIntosh and Lisa McLaughlin
This law expanded Medicaid eligibility to adults with incomes up to 138% of the federal poverty level
Affordable Care Act
Patients must sign this before they can be treated and billed.
Consent to Treatment or Financial Responsibility (these may be in the same document)
When a claim is denied because the insurer says the service wasn't necessary, the formal request to overturn that decision is called this.
Appeal
This insurance becomes available to most Americans when they turn 65 or if they become disabled.
Medicare
Brand name Suboxone is a combination of these two drugs
buprenorphine and naloxone
This law forbids knowingly billing incorrect or inaccurate information to government payers
False Claims Act
These must be completed before a patient can be seen per payer or plan requirements for the requested service(s).
Prior authorizations
This payer term describes the maximum amount an insurer will consider for a single service.
Allowed Amount
This is a claim that was stopped by payer and will not process any further until the error is fixed.
A rejected claim
Workit's name was inspired by this phrase, "It works if you work it" which comes from this 12-step recovery program.
AA or Alcoholics Anonymous
This Federal statute prevents providers from financially benefiting from referrals to other providers or products.
Anti-Kickback Statute
This plan type requires a patient to see a primary care provider to manage their care and to refer them to a specialist.
Health Maintenance Organization, or HMO
An insurance payer's systematic process of reviewing healthcare claims to determine if and how much they will pay the provider for services rendered
Adjudication
There are two Place of Service codes and two modifiers that can be used in various combinations to identify a claim as telehealth. What are they?
POS: 02, 10
Mods: GT, 95
Workit saw its first patients in this Michigan town
Canton
This agency’s work includes auditing healthcare providers, investigating fraud, and publishing a “fraud alert” list and enforcement actions (commonly cited in billing compliance).
Office of Inspector General (OIG)
When a patient has more than one insurance plan, this determines which pays first.
Coordination of benefits