Bills
What is the form hospitals use to bill Medicare and other commercial payers for facility services?
UB-04
What is the portion of the bill the patient is responsible for after insurance pays.
Co-insurance or Co-payment
What is the name of the document that explains how a claim was processed and paid by the insurance?
EOB
Which denial code means the claim was submitted after the payer’s deadline?
CARC 29 -The time limit for filing has expired.
I speak without a mouth and hear without ears. What am I?
Echo
What is the term that refers to the amount a facility charges for a service before any insurance adjustments?
Billed Charge
What is the process of determining which insurance pays first when a patient has multiple plans?
Coordination of Benefits (COB)
What is the process of identifying and recovering overpayments?
recoupment or takeback
This denial code is used when the claim is a duplicate of one already submitted.
Carc 18- Exact duplicate claim
What has hands but can’t clap?
A Clock
What code on the claim identifies the department or type of service provided?
Revenue codes
What is the maximum time allowed to submit a claim to the payer called?
Timely filing requirements
What is the term that refers to a fixed amount paid to a facility for a specific diagnosis?
What is a DRG (Diagnosis-Related Group)
This denial code indicates that the claim was denied due to lack of prior authorization.
197- Not authorized
What gets wetter the more it dries?
A towel
Which digit in the bill type code indicates the frequency of the claim, such as original, interim, or corrected?
The third
What is the formal process of challenging a denied claim?
Appealing
What is the process of identifying and resolving underpayments or overpayments?
Variance
This denial code means the claim is missing required documentation or attachments.
252- Documentation required
What comes down but never goes up?
Rain
What is the bill type code is used for a corrected outpatient hospital claim?
137
What is the process of transmitting claims to payers electronically?
Electronic claim submission or electronic data interchange (EDI)
What is the term for the amount Medicare allows for a service, which may be less than the billed charge
allowable amount
This denial code means the claim was sent to the wrong payer and must be redirected.
109
I have keys but no locks. I have space but no room. You can enter, but you can’t go outside. What am I?
What is a keyboard?