Revenue Cycle
The beginning of the Revenue Cycle.
What is Patient Access.
This is the most common reason that claims are denied.
What is missing or incorrect insurance information
This person registers patients as they come in for services.
Who is a Patient Access Representative.
The 3 rules JPS employees have to follow.
Own it, Seek Joy, Don't be a Jerk
The number required to identify a patient that received services in order to submit an insurance claim
What is a Member ID
This department does discharge planning and relies on information from Patient Access
What is Case Management
This is what an insurance company may call a procedure that they do not cover for a patient.
What is a Non Covered Service
This is the process of accurately identifying patients.
What is Patient Identity
John Peter Smith
The process of identifying which insurance should be billed first for patients with multiple insurances
When an insurance company refuses to pay a claim we have submitted to them.
What is a Denial
This is required for most inpatient admissions to start the authorization process.
What is a Notice of Admission (NOA)
This is the place where coverage is applied and charges & documentation are captured for a particular visit.
What is the Hospital Account Record (HAR)
There are approximately _______team members at JPS.
6700
The person who owns an insurance policy.
The form used to bill charges to an insurance company.
What is a UB-04 Claim
What is a Pre-Certification.
What is 3 pages.
YOU ARE IMPORTANT!
When an insurance company does not have a contract with a facility.
What is Out of Network
This portion of the Affordable Care Act returns higher Medicare Reimbursement based on Patient Experience Scores.
What is Hospital Value-Based Purchasing
This person is the VP of Revenue Cycle here at JPS and leads the Denials Prevention Taskforce.
Who is Rory McCrady
The average time it takes to complete this process is 5-7 minutes
Documents that help families & physicians make medical decisions in the event the patient is unable to.
Advanced Directives
This form is used to notify a patient that their insurance may not pay for a particular service.
What is an Insurance Waiver.