(Blank)
The 3P network
Patient, Payer and Provider
The front office executive called up the insurance and verified his eligibility for 01/21/2019. She came to know that Robert is eligible from 01/01/2019 till 12/31/2019.
What is this process called?
Insurance Verification
The codes used to track diseases and other health conditions of a patient
Diagnosis codes
The method by which the claim form is sent to the insurance by post or by courier.
Paper Claim
EMR stands for?
Electronic Medical Record [EMR]
Date of last visit should be 3 years or later.
New Patient
Robert showed up for meeting Dr. Richardson at his front office at 1pm on 01/21/2019. The front office executive requested him to fill out forms. He also gave the insurance card copies of all insurances that he has.
What is this process called?
Patient Access
A claim form is generated after completing.
Charge Entry
The method of transmitting the claim form to the insurance by Electronic Data Interchange (EDI).
Electronic Claim
EDI stands for?
Electronic Data Interchange
An individual or institution which is licensed by the federal government to provide healthcare services.
A healthcare provider
Meanwhile, the information is scanned from the billing office is forwarded to a medical billing company and the executives review the scanned documents and extract the information pertaining to the patient, policy holder, guarantor, patient’s employer and the insurance covering the patient. The information is entered to a billing software to create a patient account.
What is the billing software called?
Practice Management System
The details of the patient are sent to.
Demo Entry
What is the software that validates a claim form?
Clearing House
EOB stands for?
Explanation of Benefits
Visits the physician on a regular basis.
Established Patient
Robert (patient) called up the office of Dr. Richardson (provider) and requested an appointment on 01/21/2019.
The doctor’s front office executive collected the basic information from him and gave him an appointment with Dr. Richardson for 01/21/2019 at 1:00 PM.
How do you call that?
Scheduling (Pre-registration)
The responsibility of following up with the patient for a payment of $20 was entrusted to another department.
What is this department called?
Patient Accounts Receivable [Patient AR]
What do you call a claim that is rejected by the software?
Dropped Claim/Rejected
Insurance AR stands for?
Insurance Accounts Receivable
Is also known as insurance, carrier, or insurer.
Payer
They identified that the patient needs to pay $20 and the insurance needs to pay for the denied procedure.
The responsibility of following up with the insurance on getting the payment for the denied procedure was given to a department in the medical billing company.
What is the department called?
Insurance Accounts Receivable (Insurance AR)
The medical codes provided are annotated on the medical records along with other treatment related information.
What is the document called?
Charge Ticket / Charge Sheet
What do you call a claim that is accepted by the software?
Clean Claim
RCM
Revenue Cycle Management