CV
This term refers to differences or deviations in the terms between the original healthcare provider agreement and how they are applied in practice.
What is contract variance?
What is NSA?
This act, passed in 2020, aims to protect patients from surprise medical bills for out-of-network services.
This agreement is made between the insurer and the out-of-network provider to allow services to be billed and reimbursed at an agreed rate for just one patient.
What is a Single Patient Agreement (SPA)?
This plan offers more flexibility in choosing healthcare providers than HMO, including out-of-network options.
What is PPO?
Name the CPT code series belonging to Radiology. (+100 points if you can name a common CPT code)
70000 Series
This occurs when the payment received from an insurance company is less than the expected or contracted amount for a healthcare service.
What is an underpayment?
The No Surprises Act prohibits this common practice, where out-of-network providers bill patients for the difference between their charges and the insurance payment.
What is balance billing?
SPAs should be sent to which email for the SPA team to review?
This code system, maintained by the American Medical Association, is used to describe medical, surgical, and diagnostic services for billing purposes.
What is a CPT code?
This Right Revenue Lane manages the large database that houses all of RP's payor contracts and its details.
What is Payor Contract Administration?
Providers may file this when they believe that:
What is an appeal?
a formal request made by a healthcare provider to an insurance company or payer to review and reconsider a payment that was made for services rendered.
When insurers and out-of-network providers can’t agree on a payment, this is the process they use to settle the dispute under the No Surprises Act.
What is independent dispute resolution?
In a Single Patient Agreement, this party negotiates with the out-of-network provider on behalf of the insurance company to determine payment terms for a specific patient.
What is a repricer?
In the RCM process, this step is required by insurers before certain treatments can be approved and reimbursed.
What is RP's mission
To Transform Radiology
This person is the manager of the Contract Variance Team.
Who is Jessica Dilworth?
Under the No Surprises Act, patients are only required to pay this rate when they receive emergency care from out-of-network providers.
What is the in-network cost-sharing rate?
SPAs help avoid these unexpected charges that can occur when a patient unknowingly receives care from out-of-network providers.
What are surprise medical bills?
This is the amount that patients are responsible for paying out-of-pocket after their insurance processes a claim.
What is the patient’s financial responsibility (or copay, coinsurance, deductible)?
Name the AVP of Right Revenue.
Mike Cardinal
This is the maximum time period a provider or patient has to file an appeal after receiving a denial of claim or coverage from an insurer.
What is the appeal filing limit (AFL)?
This process requires you to submit the 3 following key components: Charge Information, Proof of sending the open negotiation letter to the payor, EOB for the charge
What is IDR Submission?
Name at least 2 Repricers.
Zelis, ClaimTech, Mitchell, Multiplan, HRGi, etc.
What is BUCHA? Name 3 out of 5.
The big 5 payors in healthcare: BCBS, UHC, Cigna, Humana, and Aetna
Name RP's values
Integrity, Teamwork, Excellence, Service, Accountability (ITESA)