Purple Rain
According to RSI what is the source of truth? Latitude or the client system ?
What is the client system
What is the term for an agreement that determines which insurer has primary responsibility for payment an which has secondary responsibility
What is coordination of benefits
What is the billing claim form for the professional charges
What is a CMS-HCFA 1500
What is covered under Medicare Part B?
What is outpatient services
What is the State Government Plan/Payer of Last Resort
What is Medicaid
The electronic notification of how the claim was processed and/or paid is known as?
What is an ERA or electronic remittance advice
What is the practice of reviewing requests for hospital admission before the patient actually enters the hospital known as?
What is pre-admission certification (Pre-Cert)
A federal government insurance program for persons 65 or older
What is Medicare?
What is the term for the justification of medical services as reasonable, necessary or appropriate
What is medical necessity
The process by which a patient or provider attempts to persuade an insurance payer to pay more of a denied medical claim is known as what?
What is an appeal
What is the four-digit code grouping that is used on hospital/facility claims only
What is a revenue code (REV code)
The payment for a claim is known as?
What is reimbursement
Medicare coverage for a medical condition in which a person’s kidneys cease functioning on a permanent basis
What is ESRD or end stage renal disease
What is covered under Medicare Part C?
What is HMO plans
Medical services performed on an outpatient basis without admission to a hospital or other facility
In what year did all the states participate in Medicaid?
What is 1982
DAILY DOUBLE: What is timely filing limit to submit an inpatient appeal to Medicare?
What is 120 days from date of processing
What is the term used to describe the balance in the Patient Accounting System reflecting an opened outstanding claim?
What is insurance accounts receivable or IAR
Drugs and prescriptions are covered under what part of Medicare?
What is Medicare Part D
What is the application process for a provider to participate with an insurance carrier?
What is credentialing
What set of codes on a claim form describe why a procedure/service was performed for said patient
What are ICD-10 or diagnosis codes
What drives the medical reimbursement on an inpatient claim?
what is the DRG or diagnosis-related group
What Remark code is used when a CPT/HCPCS code denies for no authorization/ pre-certification?
What is CO-197
In Medicare, HIQA is abbreviated for?
What is Health Insurance Query Access