Revenue Cycle Basics
What does EOB stand for?
Explanation of Benefits
Name a coworker who has worked here more than ten years.
Alisha, Fran, Jamyee, Sheena,
A claim is denied because the patient's date of birth was entered incorrectly. Which area of the revenue cycle most likely caused the error?
Patient Registration
What gets wetter the more it dries?
A towel.
A claim is denied with CO-16. What does this generally indicate?
Missing or incomplete information required to process the claim.
What process confirms a patient's insurance is active before the visit?
Insurance Verification
Which UNC Health value includes the statement, "We are better together than we are apart"?
One Great Team.
A payer denies a claim stating "coverage terminated prior to date of service." What process should have identified this issue before the visit?
Eligibility Verification
What has keys that can't open locks?
A piano
A procedure is performed bilaterally but billed as a single service. What modifier may need to be considered?
Modifier 50
What document is often required before certain procedures or services are performed?
Prior Authorization
In what year was UNC Health established by the North Carolina General Assembly?
1998
A patient has Medicare and a commercial secondary plan, but Medicare was billed first and denied due to incorrect payer order. What process was missed?
Coordination of Benefits (COB)
A plane crashes exactly on the border between North Carolina and Virginia. Where do they bury the survivors?
You don't bury survivors.
A provider performed two unrelated procedures on the same day. The payer bundled them together. What modifier might support separate reimbursement?
Modifier 59
What is the term for a payer refusing to pay a claim?
Denial
Who is our team's manager?
Teresa Couch
A claim was submitted 14 months after the date of service and was denied. What payer requirement was likely missed?
Timely Filing
The more you take, the more you leave behind. What am I?
Footsteps
A service was repeated by a different provider. Which modifier may be appropriate?
Modifier 77
What is the first step in the revenue cycle process?
Patient Registration/Scheduling
Name three hospitals within the UNC Hospitals system in Chapel Hill.
A physician performs a procedure that required prior authorization. The authorization was approved, but the claim was denied for no authorization on file. What should be investigated first?
Whether the authorization number was linked to the correct patient, date of service, location, or CPT code.
A farmer has 17 sheep. All but 9 die. How many are left?
9
A procedure was started but discontinued due to extenuating circumstances. Which modifier is commonly associated with discontinued procedures in the outpatient setting?
Modifier 53