HIPPA
This must be kept confidential, and only disclosed when necessary for treatment, payment, or healthcare operations.
Personal Health Information (PHI)?
The claims have been processed and deemed unpayable. These claims may violate the terms of the payer-patient contract, or they may just contain some sort of vital error that was only caught after processing.
What is a Denied Claim?
Who is responsible for performing check-in within Acumen 2.0.
What is the Practice?
KPI stands for?
What is Key performance Indicators?
A third-party organization that reviews, edits, and formats claims before submission to insurance.
What is a Clearinghouse?
(True or False) Failure to safeguard all confidential information does not have financial impact.
What is False?
This term is used when a claim contains one or more errors found before the claim is processed by the payer. These errors prevent the insurance company from paying the bill as it is composed.
What is rejection?
Who is responsible for obtaining authorizations.
What is the Practice?
Industry best standard for AR Days.
What is 38?
This explains to the healthcare provider and to the patient which services that were performed are covered by the patient's insurance plan.
What is an Explanation of Benefits (EOB)?
Example of Personal Health Information (PHI).
What is (One of these) Bank account numbers, Social security Information, Credit card Information, Tax Information, Birth date?
This role within revenue cycle is one that requires determining why the payment has not been received or why a claim underpaid.
Who is insurance follow up rep.
Once the payer has paid the claim, who is responsible for posting the money?
What is RCM?
Industry standard in denial rate (Percentage).
What is 4%?
A healthcare provider that is contracted with a managed care organization.
What is an "in-network" Provider?
When should you notify a lost or stolen USB containing PHI information?
What is Within 24 hours (Immediately)?
These codes can be found on the EOB and explains the reason why the payer did or did not pay.
What are Denial/ANSI/Remit Codes?
Who is responsible for following up with the payers if the payer has not paid on the claim
What is RCM?
Industry standard for write offs as a percentage of net revenue.
What is 2.6%?
A patient may pay this every time he or she visits a medical care facility or fills a prescription.
What is a copay?
What is social engineering trick to obtain sensitive information (such as passwords or credit card details) by playing on emotions to get the user to click a link or download something?
What is Phishing?
This type of denial will occur whenever a specific number of days has past from date of service and will result in the claim being unpayable.
What is a timely filing denial?
(True or False) Collecting patient insurance information is done post visit
What is False?
It's best practice to collect all patient demographic and insurance information before the patient is seen.
The industry standard for charge lag days
What is less than 3 days?
After the patient is treated, the care facility records the diagnosis and treatment information into this Electronic Medical Record system.
What is Acumen 2.0?