Research Cash
This term describes the statement issued by the payer to the insured explaining services provided and the payments rendered to the provider
What is EOB
Patients may have coverage benefits available to them under more than one insurance plan. This additional insurance policy is referred to as
What is Secondary
This is the payor of last resort
Who is Medicaid
Some might say this husky rascal ensures that benefits paid by all policies do not exceed 100% of charges.
What is COB (Coordination of Benefits)
This is the term used for the amount charged for a medical insurance policy
What is Premium
This section in Reggie will show you inactive coverage policies for a patient
What is Insurance Policies
This is the amount of money a patient pays out of pocket prior to insurance payment for health care visits and services
What is a deductible
This is the means in which electronic claims are submitted
What is Electronic Data Interchange (EDI)
A provider bills $400 for a test. The insurance pays $300 and the patient’s responsibility is $23.56. What is the contractual discount and what is the patient’s responsibility called?
What is
$100, Co-insurance
This is the name of the Federally funded program for low-income individual
What is Medicaid
This is what MPI stands for...
What is Master Patient Index
This team is responsible for accurate recording of demographic and insurance information at time of scheduling
Who is Patient Registration
These two Policy Statuses in Reggie are the most ideal for us to review a policy
What are Insurance Terminated - No Action Required and Complete
____________ is a monthly payment to purchase and continue insurance coverage. A ____________ is how much money you must pay before your insurance begins to pay for medical services. A ____________ is a flat fee you must pay every time you see the doctor and __________________ is a percentage you must pay in addition to other fees.
What are
premium, deductible, co-pay, coinsurance
The Blue Plan Codes always match from Reggie to Nautilus/VIA.
False
Accounts placed in “Bad Debt” are claims that remain unpaid despite attempts at payment arrangements.. These accounts are deemed
What is uncollectable/determined to be uncollectable
What type of claim is this?
****See PP slide****
Why would this be a refund?
A patient cannot possess a Medicare Advantage plan and supplemental insurance policy. It goes against government rules.
For Plan Changes, the three places to locate the root cause is under the Manual Verifications tab, Reggie Notes and
Intentional deception or misrepresentation is considered this
What is Fraud
In your workbench, how would you status the voided claim and what note would you use?
***See PP Screen share***
Health care administrative and clinical functions related to the capture, management, and collection of revenue for the health care services received during a patient encounter is called
What is Revenue Cycle Management
This is the name of an insurance carrier's process for evaluating claim for payment
What is Adjudication
Who sets the rules for filing claims, such as which services are covered, the reimbursement rates, and the deadlines for filing and paying claims?
Who is the Insurance Provider/Company
BOOMERANG! This is the method employed by the healthcare organization to monitor services rendered, from patient registration and appointment scheduling to the conclusion of payments for services
What is Revenue Cycle Management