Dior
The process that tracks a patient encounter from registration to final payment
What is the revenue cycle?
The first thing to check when a claim is unpaid after 30 days
What is claim status?
A denial stating the service was not covered by the patient’s plan
What is a non-covered service denial?
The amount a patient pays before insurance begins to pay
What is a deductible?
All steps of Insurance Updating
What is
1. Enter Correct Plan code in PM Office/ Invision
2. 28 Record if no new bill is needed
3. Scan eligibility into Rasi
3. Add stat charge code
4. Check insurance balances next day
5. If payment email cash posting to transfer pymt
The stage where claims are reviewed for accuracy prior to submission
What is claim scrubbing?
When insurance says they never received the claim
What is a claim not on file?
The formal process of requesting reconsideration of a denied claim
What is an appeal?
The percentage a patient owes after deductible is met
What is coinsurance?
CMDI act code/process
The department responsible for posting payments and adjustments
What is payment posting?
A best practice timeframe to follow up on unpaid claims
What is every 30 days (or per payer guidelines)?
A denial caused by missing authorization
What is a prior authorization denial?
A fixed amount a patient pays for a service
What is a copay?
A denial involving multiple payers disagreeing on responsibility
What is coordination of benefits?
Codes that describe what service was performed
What are CPT/HCPCS codes?
The federal law protecting patient health information
What is HIPAA?
Documentation typically required before initiating a payer escalation
What are call reference numbers, claim history, and EOBs?
Rule that states coins will be 20% of payment.
What is Medicare outpatient 80/20 rule?
A quarter of a day in Kronos
What is 1.87?
Codes that explain why the service was provided
What are ICD-10 diagnosis codes?
Submitting a claim after the filing limit results in this
What is a timely filing denial?
A payer violation when claims are not processed within mandated timeframes
What is a prompt-pay violation?
Code indicates patient responsibility on an electronic EOB?
Nicole's middle name
What is Jenean?