Denial Reporting
The percentage of claims denied upon initial submission.
What is the First Pass Denial Rate?
The timeframe used as the performance starting point for a client engagement.
What is the Measurement Period? (also accept Baseline period)
Shout out to Bob, who helped me with these Jeopardy Q&A. The ensemble approved artificial intelligence tool.
What is CoPilot?
KPI
What is Key Performance Indicator?
A structured method used to identify the underlying cause of a denial.
What is Root Cause Analysis (RCA)?
This is posted when all appeal and reconsideration efforts are exhausted while the payer maintains their denial decision.
What is a final denial adjustment
The transactions approved for inclusion within measured performance results.
What are In-Scope Transactions?
The Power BI application that contains client facing financial information, with the acronym ERP.
What is the Enterprise Report Package?
SLA
What is Service Line Agreement
The monthly presentation to the client, showcasing current rates, trends, and denial prevention efforts.
What is Denial Prevention Committee (DPC)?
A grouping used to organize similar denials such as authorization, eligibility, or medical necessity.
What is a Denial Category or Denial Reason?
A change made when the baseline measurement is no longer accurately reflecting the operational reality. As in reversing R&B charges rather than adjusting them in a denial.
What is a Baseline Adjustment or Rebaseline?
This is the tool used to keep live notes. We use it for Baselines, Assessments, and our DIBS.
What is Loop?
POS
What is Place of Service? or Point of Service
The team that owns front end authorization errors for scheduled services.
What is Pre-Access?
This is a code used by the payer to identify the reason they are denying payment. i.e. 39-Services denied when the authorization/pre-certification was requested.
What is CAS Code or CARC
This is the platform used to initiate changes in transaction code mapping.
What is aha!?
All of Ensemble's policies are in this centralized location, with a link on TEDI.
What is PolicyTech? (NavexOne)
TEDI
This is the name of the teams chat to use when a denials prevention question arises, and you want to ask the entire denial prevention team.
What is RP - All Hands Business Chat?
This is the code applied into the host system by accounts receivable to indicate the type/reason for the final denial adjustment.
What is a Transaction Code
They type of calculation used to determine the impact to net revenue, through denials reduction efforts.
What is lift?
Ensemble's proprietary software is a cloud-based, analytics-driven, workflow automation platform for revenue cycle management.
What is Ensemble IQ or EIQ?
SMART
What is Specialized Mentor and Rev-cycle Trainer?
The first and last name of the VP for the Denials Avoidance team that includes Assessments and Integrations, Denials Prevention and Clinical Denials.
Who is Nichol Cobaugh?