Referrals
Involves building relationships with providers and organizations to increase brand awareness and grow a customer base.
What is Growth and Outreach?
A message that explains why a payer refuses to remit for an item on a submitted claim.
What is a denial code?
A group of insurance packages that use the same allowable schedule.
What is an allowable category?
The credit balance in a patient account, excluding any prepayment balance.
What is an unapplied balance?
What is the first impression?
The intent is to ensure that the service is medically necessary, clinically appropriate, and aligns with evidence-based guidelines.
What is a prior authorizaztion?
This is a waiver of liability form for Medicare patients.
What is an ABN (Advanced Beneficiary Notice)?
The athenahealth EMR service solution. Includes a fully customizable patient encounter form, clinical document-handling services, and a paperless workflow for patient chart administration.
What is athenaClinicals?
An amount of money that does not appear to be a payment for a charge.
What is unpostable?
Value Creation, Marketing, Sales, Value Delivery, and Finance.
What are the five stages of a business?
A written order from your primary care doctor for you to see a specialist or get certain medical services.
What is a physician referral?
A write-off amount equal to the difference between the payment expected for a service (allowable amount) and the payment that is actually received for the service.
What is an adjustment (contractual)?
This tool allows you to serach medical billing reference books, the CPT and HCPCS databases, Medicare manuals, federal guidelines, and more.
What is athenaCodesource?
The items and amounts that a practice expects to receive for services rendered.
What is accounts receivable?
Giving your customers what you've promised and ensuring they're satisfied with the transaction.
What is Value Delivery?
You access and work them timely when managing this box.
What is the clinical inbox?
A process by which a patient, a provider, or a hospital can object to a health plan when there is a dispute about the health plan's decision to not pay for care.
What is an appeal?
A set of authorized athenaOne functions, or "user permission." They are used to control user access in athenaOne.
What is a role?
A fixed sum of money to be paid by the patient to the provider for a covered service. It usually appears on the front of the patient's insurance card.
What is a copay?
The process of addressing and fixing issues with patient care or clinical services.
What is Service Recovery?
Information about the origin of incoming patient referrals, including the referring doctor or specialty, and how referral trends change over time.
What is an incoming referral report?
Notification from the payer that a patient is covered for provider services under an insurance plan.
What is eligibility verification?
A queue of work items that need user action to resolve. The most common worklists contain links to claims, but others contain links to items such as missing slips, appointments, and patients.
What is a worklist?
This is a document that usually accompanies a check from an insurance company. It details each charge on a set of claims, and shows claim numbers, financial information, and/or denial information about the set of claims.
What is an EOB (explanation of benefits)?
The 3 A's of healthcare.
What are availability, affability, and ability?