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Allscripts
scheduling and registration happens here
What is the Front End?
A healthy revenue cycle is closed in this timeframe
What is 45-55 Days?
What is the required documentation for an adjustment?
Source/Type of Adjustment
Reason for Adjustment
Amount of the Adjustment
What page in the CBO can Adjustment types and their transaction codes be found?
Page 100
EHR
services administered, documentation, charge capture, and coding happen here
What is the Middle?
The definition of denial
Denials are considered claims that an insurance company has determined they will not pay due to a specific reason. A denial can be the result of errors on the part of the provider, the payer, the patient or even data entry errors.
What is the required documentation for an appeal
• What is the Discrepancy Identified (source of the discrepancy)
• Expected reimbursement, amount of short-pay, and denied amounts when applicable
• Action taken to resolve the discrepancy
• Method of appeal submission, payer portal, verbal or address where paper appeal was mailed
Page 179
Where do you go to edit your notes in Allscripts
The notes tab
Billing, Collections, Cash Posting, Pater to provider correspondence happen here
What is the Back End?
When working a non-covered denial, what is the first step in resolving the claim?
What is Check the EOB for clarification and call the insurance if you need additional information?
What is the required documentation for reconsiderations?
• What is the Discrepancy Identified (source of the discrepancy)
• Expected reimbursement, amount of short-pay, and denied amounts when applicable
• Action taken to resolve the discrepancy
• Method of reconsideration submission, payer portal, verbal.
What page in the CBO gives information on updating ailment information for Workers Comp?
Page 115
Where do you go to view a cms 1500
Account ledger
What is the difference between an EOB and an ERA
ERA- targeted toward the provider, this is an itemized bill, can list payment information for multiple patients
EOB- this is targeted toward the patient, solely gives payment information for a single patients claims
When working a COB denial for a Two or More Payer Denied claim, what is the first step?
Run an eligibility check to verify there is another payer listed
All notes should have a claim number if one was provided or found by the rep (True or False)
True
What are PHCT's claims scrubbers?
RCX and ClaimStaker
What tab do you complete VRE's under
The edits tab
Definition of Deductible
The amount paid for services before the insurance plan starts to pay
When working a modifier denial what document can be referenced for assistance in making the needed corrections?
Modifier Grid- Primary Care
payer name, phone number called, reps name, status of claim or why payer was contacted, payment details if applicable, reference and claim numbers, in addition to the note elements below based on the outcome of the call.
What tool can be used to find out if certain payer will pay for specific procedures?
Master Payer Guidlines