Registration
A responsible party and/or insured party who is not necessarily the patient.
Who is a "Guarantor"
The United States federal government health insurance program for Americans who are 65 years of age or older
What is "Medicare"?
Person responsible for the discharge status code
Who are the coders?
A document required before scheduling a service
What is an order
Claims for discharged patients that billing has not received
What is "Discharged, Not Final Billed" (DNFB)?
This is sometimes required by a patient’s insurance company to determine medical necessity, but does not guarantee benefits will be paid
What is "Pre-Certification:?
These are costs that are a patient's responsibility for hospitalization between day 61-90 days
What are "Medicare Coinsurance Days"?
The time between discharge and final bill.
What are lag days?
A service that does not require an order?
What is a mammogram?
Outstanding charges that are the patient's responsibility that have not been successfully collected which are eventually written off and sent to a collection agency
What is "Bad Debt"?
This is a Medicare notice a provider should give you before your receive a service to disclose your liability.
What is an "Advanced Beneficiary Notification" (ABN)?
This is a healthcare program that supports low-income families or individuals
What is "Medicaid"?
The person responsible for submitting 3rd party insurance claims
Who is the patient?
A service that does not require a co-pay for Medicare patients.
What are lab services?
The bill form used for all hospitals
What is the "UB04"?
A confirmation of coverage
What is "Eligibility"?
This payer does not require authorizations for inpatient stays
What is Medicare?
Charges most likely to come in late.
What is pathology?
Information the patient needs before arrival
What is their financial responsibility?
A notice you receive from your insurance explaining the benefits received and not received
What is an EOB?
The form given for patients to appeal their discharge?
What is an IM or Important Message from Medicare?
The service that almost always requires an authorization from insurance?
What is Inpatient?
The electronic document holding all charging information.
What is the chargemaster?
Important clinical information needed before testing to ensure payment.
What is medical necessity?
The amount that an insurance policy holder has to pay out of pocket before the insurance begins paying?
What is the deductible