Terminology
CPT CODE
The Current Procedural Terminology (CPT®) codes offer doctors and health care professionals a uniform language for coding medical services and procedures to streamline reporting, increase accuracy and efficiency.
CO 50
These are non-covered services because this is not deemed a "medical necessity" by the payer.
Clean Claims Ratio
A clean claims ratio is the share of claims accepted and paid on the first submission. A low clean claims ratio means your claims are frequently denied or require clarification, which may signal a problem with your coding, documentation, or claims submission processes.
Prior Authorization and Referral Issues
Denials related to lack of prior authorization or referral documentation are prevalent in medical billing. Failure to obtain necessary authorizations or referrals for specific procedures or specialist consultations can result in claim denials.
70010–79999 - What section does these codes belong to?
Radiology Procedures
DX code
A diagnosis code is a combination of letters and numbers that represents a certain medical condition, procedure, symptom, or disease.
CO 51
These are non-covered services because this is a pre-existing condition.
Denial Rate
Similar to the clean claims ratio, the denial rate is the share of all submitted claims that were denied. A high denial rate warrants further investigation to identify the source of incorrect claims. Tools like TempDev's Revenue Cycle Dashboard NextGen EPM Report provide denial statistics by reason for denial to help your practice identify common errors.
Medical Necessity Denials
Payers may deny claims if they deem a service or procedure as not medically necessary. This denial often arises from insufficient documentation supporting the medical necessity of the service provided.
99091–99499 - What section does this codes belong to?
Evaluation and Management Services
ABN
An Advance Beneficiary Notice (ABN), also known as a waiver of liability, is a notice a provider should give you before you receive a service if, based on Medicare coverage rules, your provider has reason to believe Medicare will not pay for the service.
PR 1
Accounts Receivable Aging
Accounts receivable are all your billed charges that have not yet been paid, including both insurance and patient bills. Your average accounts receivable days is an estimate of how long it takes your practice to collect payments. Your practice should also track the share of accounts receivable that are outstanding for more than 30, 60, and 120 days. Practices with healthy revenue cycles generally clear accounts receivable within 50 days or less.
POA indicator is invalid
Present on admission is defined as a condition present at the time the order for inpatient admission occurs. Conditions that develop during an outpatient encounter prior to an admission to inpatient, including emergency department, observation, or outpatient surgery, are considered as present on admission
99281-99285 - Which section does these codes belong to ?
Emergency
AOB
The term assignment of benefits (AOB) may be referred to as an agreement that transfers the health insurance claims benefits of the policy from the patient to the health care provider.
CO 147
Provider contracted/negotiated rate expired or not on file
AR SPLIT
The percentage of AR below and above 90 days of Age
What is the purpose of occurrence codes in UB04?
Occurrence codes and their respective dates disclose the payer-specific event(s) related to the billing period on the UB04. They are located in boxes 31 - 36 on the UB04.
10000–69990- Which section does these codes belong to ?
Codes for surgery
What is the full form of COBRA
COBRA stands for Consolidated Omnibus Budget Reconciliation Act.
CO 55
Claim/service denied because procedure/ treatment is deemed experimental/ investigational by the payer.
Free 500
Free 500 Marks
Denied for Taxonomy Code
This rejection indicates that a Taxonomy Code is missing on the Claim. If the Taxonomy Code is required in box 33b you will enter a Taxonomy for the Billing Provider on the Claim. We recommend adding a Taxonomy Code related to Organization for the Insurer.
80000–89398 - Which section does these codes belong to?
Codes for pathology and laboratory