Revenue Cycle Basics
What is the first step in the revenue cycle?
What is patient registration/scheduling?
Patients should always present this at registration.
What is a photo ID and insurance card?
This federal program primarily covers patients age 65 and older.
What is Medicare?
Medicaid is primarily funded by these two entities.
What are state and federal governments?
This is the fixed amount a patient pays at the time of service.
What is a copay?
This law protects patient privacy.
What is HIPAA?
This confirms if coverage is active on the date of service.
What is eligibility verification?
Missing insurance information commonly causes this.
What is a denial?
This process confirms insurance is active before services are provided.
What is insurance verification?
This must match exactly between the insurance card and registration.
What is the patient’s name/date of birth?
This form is given to Medicare patients admitted as inpatients.
What is the Important Message from Medicare (IM)?
Patients often qualify for Medicaid based on this.
What is income eligibility?
This is the amount a patient owes before insurance begins paying.
What is a deductible?
Staff should never discuss patient information in this public area.
What is hallways/elevators/cafeteria?
This insurance term identifies the person who holds the insurance policy.
What is the subscriber?
Collecting accurate demographics helps prevent these billing problems.
What are claim rejections and denials?
Collecting copays at registration helps reduce this.
What is bad debt/accounts receivable?
Failure to update demographics can lead to this billing problem.
What is claim denial/rejected claims?
This notice is provided to observation patients to explain their status.
What is the MOON form?
This happens if Medicaid eligibility is not verified correctly.
What is claim denial/nonpayment?
This process may be required before certain tests or procedures.
What is prior authorization?
This consent allows treatment by hospital staff/providers.
What is consent for treatment?
If two insurances exist, staff must determine this.
What is primary vs. secondary insurance?
This happens when a claim cannot process because of incorrect information.
What is a rejected claim?
This department submits claims to insurance companies after coding.
What is patient financial services/billing?
This form explains a patient’s rights as a hospital patient.
What is the Patient Rights and Responsibilities form?
The initial IM must generally be delivered within this timeframe of admission.
What is within 2 calendar days of admission?
Medicaid programs may differ depending on this.
What is the state?
This insurance term refers to providers contracted with the insurance company.
What is in-network?
This occurs when staff access a chart without a work-related reason.
What is a HIPAA violation?
Incorrect insurance order can result in this.
What is claim rejection/denial?
This front-end process has the biggest impact on clean claims.
What is accurate registration?
A denied claim affects this hospital metric related to payment delays.
What is accounts receivable (A/R) days?
If a patient refuses to sign consent forms, staff should do this.
What is document refusal and notify leadership/provider?
This Medicare part typically covers hospital inpatient stays.
What is Medicare Part A?
This type of Medicaid program is commonly used for managed care.
What is Medicaid Managed Care?
If insurance requires authorization and it is not obtained, the result may be this
What is denial of payment?
Protected Health Information is commonly abbreviated as this.
What is PHI?
This insurance rule determines which plan pays first.
What is Coordination of Benefits (COB)?
A “clean claim” means this.
What is a claim submitted correctly the first time without errors?