Monday
Routine heath care that includes screenings and check-ups to prevent illnesses, diseases or other health issues
Preventive Services
Timely Filing
A unique 10-digit number assigned to a health care provider or hospital/facility
National Provider Identification Number
Coinsurance is defined as
A percentage of a medical charge that a patient pays that typically applies after a patient’s deductible has been met.
Non-government Insurance is known as
Commercial health insurance
Set of codes describing/noting the patient’s medical condition on the claim
Current Procedural Terminology Codes (CPT)
Internal Classification of Disease Codes (ICD-10 CM)
The dollar amount above the insurance company’s allowed amount for the submitter charges
Contractual Obligation/Adjustment/Write-off
Billing claim form for the professional charges
CMS-HCFA-1500
The process by which a patient or provider attempts to persuade an insurance payer to pay more of a denied medical claim
Appeal
A Facility/Provider who has a contract with the patient’s health insurer or plan to pay for services
In-network provider
Set of five-digit codes for billing and authorization of evaluation and management services broken down into groupings
Current Procedural Terminology Codes (CPT)
The insurance company with the first responsibility for the payment of a claim
Primary insurance company
What the payer says they will consider out of the submitted line item charges (total charges)
Allowed Amount
. Practice of reviewing requests for hospital admission before the patient actually enters the hospital
Pre-admission certification (Pre-Cert)
The number assigned by the health insurance company when they accept a claim in their system for review and payment
Document Control Number (DCN)
Charges that are billed for a hospital/facility on a UB-04
Technical Charges
Criteria for a patient to be considered an inpatient
2 Midnight Rule
. Hospice falls under what Part of Medicare
Medicare Part A
Can you appeal Medicare Advantage plan denials?
Yes
Does the Medicare deductible for Part A & B change on a yearly basis?
Yes
When a claim denies for no authorization/ pre-cert what are some questions not to ask talking to an insurance representative?
Who authorized this service?
What Remark code is used when a CPT/HCPCS code denies for no authorization/ pre-certification
CO 197
Date an insurance company completed processing, paying or denying a claim
Processing Date
According to RSI what is the source of Truth?
Client system
What 2 Remark codes are typically used on a remittance advice (ERA) when a CPT/HCPCS code denies for Medically Unlikely Edits (MUE)
CO 151
CO 222