Payment Reconciliation
Total amount paid plus any patient responsibility, plus sequestration (if a MCR or MCR Adv acct), equals this...
What is "the Allowed Amount"?
This auto adjustment is posted to the encounter to reflect the difference between total charges and what our expected reimbursement is.
What is a "Contractual Adjustment"?
This code is placed on an account to identify specific payer issues, track trends and for escalation purposes...
What is "a UFC code"?
This is an EOB with a virtual credit card attached sent in as payment from some insurance companies...
What is "a Quick Remit"?
This reimbursement rate is a fixed amount for each day the patient is in-house.
What is "Per diem"?
MCR and MCR Advantage are allowed an additional 2% reduction to what they pay, this is referred to as..
What is "Sequestration"?
Adjustments that use a "W" T-Code are this kind of adjustment...
What is a "Write Off"?
There are this many levels of UFC codes...
What is "6"?
These EOBs do not have any payment attached and they have code that identify why charges were not covered...
What is a "Denial/Zero Pay"?
This determines the patients level of care.
What is the "Accommodation Code"?
We are not allowed to bill MCR and MCR Advantage patients for copays, coinsurance or deductibles if they are this...
What is "QMB Eligible"?
Placing brackets around the adjustment amount indicates this...
What is "you are increasing the balance by this amount"?
This Level 2 UFC is used for a coordination of benefits issue...
What is "COBI"?
This portal is used for Payment Move Forms, Posting Errors or corrections on payments needed, Missing payments (only when insurance states payments were cashed...
What is "Cash Review"?
A Responsible Party we use to determine the contracted reimbursement information.
What is the "Insurance Plan Code"?
Use this tool to check what the contracted rate of reimbursement is for a specific payer...
What is the "Contract Grid Tool"?
The BP date utilized in an adjustment request is what date on the encounter?
What is "Discharge Date / BP End Date"?
This level 3 UFC code is used when a facility update is needed...
What is "FUND"?
Allow this many business days for corrections to be made before placing a request for a posting error...
What is "3 business days"?
This reimbursement rate is based on a fixed amount based on the HIPPS pricer.
What is "CMG rate"?
Use Millenium to review a patients QMB Eligibility under this tab...
What is "Insurance"?
An adjustment request for an amount over $10,000.00 requires this many levels of approval...
What is "3"?
When accounts need additional assistance from the facility or to notify it of any account issues that may have a a high financial impact, Their information is added here...
What is "the Action Item Log"?
Adjustment corrections will be made only if the error was made by this team...
What is "the Cash Team"?
When we are expecting the lesser of two payment methods from an insurance, the rate they pay is considered this...
What is the "Less of Clause"?