Eligibility & Registration
This should be verified before every visit to avoid billing the wrong payer.
What is insurance eligibility?
These codes describe the services performed
What are CPT/HCPCS codes?
This denial means the claim was received after the filing deadline.
What is a timely filing denial?
This Medicare payment systems covers most services provided during a skilled nursing facility stay
What is consolidated billing?
This document explains why a claim was denied or adjusted
What is an Explanation of Benefits (EOB) or Electronic Remittance Advice (ERA)
This number uniquely identifies a members health plan coverage.
What is the member ID number?
These codes explain why the service was medically necessary.
What are ICD-10 diagnosis codes?
This denial occurs when a patients coverage was inactive on the date of service
What is an eligibility denial?
This Medicare program primarily covers physician and outpatient services
What is Medicare Part B
Failure to obtain this can lead to claim denials for many payer types
What is prior authorization?
This determines whether a provider is in-network or out-of-network.
What is provider participation/contract status?
The financial process from scheduling through payment collection
What is Revenue Cycle?
This denial means additional clinical documentation is needed to support payment
What is a medical necessity denial?
These HCPCS codes are excluded from SNF consolidate billing and may be billed seperately
What are consolidated billing exclusion codes?
This process requests the payer to reconsider a denied claim
What is an appeal?
Failing to obtain this when required often results in a denial.
What is prior authorization?
This coding system is used for inpatient hospital procedures
What is ICD-10 PS?
This denial occurs when another insurance should have been billed first
What is a Coordination of Benefits (COB) denial?
This CMS system determines whether a beneficiary is in a covered SNF stay
What is the Common Working File (CWF)
This supporting informaiotn is often requred to overturn medical necessity denials.
What are medical records?
This government program is always the payer of last resort when other coverage exsits.
What is Medicaid?
Individuals who qualify for Medicare and Medicaid.
What are Dual Eligbles?
This type of denial indicates payment is bundled into another service
What is a bundled service denial?
This occurrence often causes Medicare Part B claims to reject because the SNF should have billed for the service
What is consolidated billing edit
This document indicates a service may not be covered by Medicare
What is an Advance Beneficiary Notice (ABN)?