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.
This is the payer of last resort (not including JPS Connection).
What is Medicaid
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 term for a payment request that is submitted to an insurance company without any errors.
What is a clean claim
This tool collects registration errors and flags them for correction prior to billing.
What is RQA
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 unplanned, 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)
This is the "A" in AIDET
What is Acknowledge
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.
This provider group provides services for most encounters at JPS.
What is Acclaim Physicians Group
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
Billing the patient for charges that the insurance did not pay. HINT: JPS does not do this.
Balance Billing
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.