Revenue Cycle Basics
This is the first step in the revenue cycle process.
What is patient registration?
This government program provides healthcare for individuals 65 and older.
What is Medicare?
These codes are used to describe diagnoses.
What are ICD-10 codes?
The denial code for "service not covered by payer."
What is CO-96?
This law protects the privacy of patient health information.
What is HIPAA?
This department ensures accurate coding for claims
What is medical coding?
This type of insurance plan requires a referral to see a specialist.
What is an HMO (Health Maintenance Organization)?
This code set is used for outpatient services and procedures.
What are CPT codes?
The first step in appealing a denied claim.
What is reviewing the explanation of benefits (EOB)?
This agency oversees Medicare and Medicaid compliance.
What is CMS (Centers for Medicare & Medicaid Services)?
The process of verifying insurance coverage before services are provided.
What is eligibility verification?
This program offers healthcare coverage for low-income individuals and families.
What is Medicaid?
This term refers to codes for durable medical equipment billing.
What are HCPCS codes?
A claim denied for missing a modifier can often be fixed with this.
What is a corrected claim?
A practice of intentionally overbilling Medicare is considered this.
What is fraud?
The percentage of costs patients are required to pay after insurance processes a claim.
What is coinsurance?
This part of Medicare covers inpatient hospital stays.
What is Medicare Part A?
A code used for a routine annual physical exam.
What is Z00.00?
This type of denial occurs when medical records don’t justify billed services.
What is medical necessity denial?
This document notifies Medicare patients their insurance may not cover a service.
What is an Advance Beneficiary Notice (ABN)?
This term describes the difference between what a provider charges and what insurance allows.
What is contractual adjustment?
This insurance type supplements Medicare and covers out-of-pocket costs.
What is Medigap?
This coding process reviews documentation to ensure it supports billed charges.
What is coding audit?
This documentation supports the appeal of a denied pre-authorization.
What is a letter of medical necessity?
The process of investigating and returning overpayments is part of this act.
What is the False Claims Act?