Systems & Navigation
What system is used to maintain patient and account information and is often the source of billing data?
What is a Host System?
Why are account notes important?
To document actions taken, support account history, and ensure compliance.
Before contacting a payer, what process should be completed to ensure the account is ready for follow-up?
What are the Preparation for Follow-Up Steps?
What claim form is typically used for hospital billing?
What is a UB-04?
What is the process called when a payer takes back previously issued payment?
What is a Recoupment?
What tool helps providers submit claims to insurance companies by checking for errors and transmitting claims electronically?
What is a Clearinghouse?
Which policies outline proper account note documentation standards?
What are Policies 1749 and 1745?
What required training provides foundational knowledge for working accounts in Ensemble IQ?
What is EIQ Collect Foundations Training?
What workflow should be followed when a payer indicates they never received the claim?
What is the No Claim on File Workflow?
When should a payer escalation be considered?
When standard follow-up efforts have failed to resolve the issue.
This system is used to analyze data, run reports, and identify trends across accounts.
What is a Data Warehouse?
What tool provides a standardized format for account documentation within EIQ?
What are EIQ Note Templates?
What should you review when opening an account from a work queue?
Claim status, account notes, account history, and outstanding balances.
What calculation helps determine how much a payer should reimburse for a claim?
What is an Expected Reimbursement Calculation?
Before submitting an adjustment request, what must be understood?
The Adjustment Request Approval Process.
What system should an AR representative use to review claim status and payer responses directly with the insurance company?
What is a Payor Portal?
What COE provides guidance on approved abbreviations and acronyms?
What is COE 3009?
Why is account preparation important before taking action?
It helps identify issues, avoid unnecessary work, and improves follow-up efficiency.
What metric helps evaluate payment accuracy against contractual expectations?
What is a PCR Rate (Payment Compliance Ratio)?
A representative receives conflicting information from a payer after multiple calls. What may be the next appropriate step?
What is a Payer Escalation?
You need to locate the accounts assigned to you for follow-up. Where would you begin?
What is your assigned Work Queue (WQ)?
Name one key element that should be included in an account note following payer contact.
representative name, call reference number, claim status, next steps, or follow-up date.
True or False: Follow-up should begin immediately without reviewing previous notes.
What is False?
Which policy helps define Account Review and Edit Ownership for Acute Billing?
What is Policy 5159?
Name three systems or tools that may be used together during account follow-up.
Examples include Host System, EIQ, Payor Portal, Data Warehouse, and Clearinghouse.