Leadership
Who is the AVP (Associate Vice President) of UT Southwestern Medical Center Revenue Cycle?
Who is Kelly Kloeckler
What does POS stand for?
Place of Service
What term describes the process of determining which insurance plan is primary when a patient is covered by more than one?
COB (Coordination of Benefits)
What is the name of the billing system used by UTSW?
EPIC
If you have health insurance, they might not agree to pay for a service your provider wants you to have unless they approve it first (and even then, they still might not agree to cover the cost). What’s the term for this process?
Preauthorization
Who is the Director of the Revenue Cycle?
Wathen Strong
A patient receives a statement explaining how their insurance company processed a medical claim. The document is known by what three-letter acronym?
EOB (Explanation of Benefits)
Who is UTSW's Medicare intermediary?
Novitas
Name 3 Provider Portals
Availity
UHC
Cigna
TMHP
Novitasphere
According to 2022 data, over 84 million Americans are covered by which government health insurance?
Medicaid
Who is the Assistant Director of the Revenue Cycle?
Malonee Garrett
This federal law mandates the confidential handling of protected health information and is a cornerstone of privacy in medical billing and collections.
HIPPA (Health Insurance Portability and Accountability Act)
The federal agency that oversees the Medicare and Medicaid programs is known by this three-letter acronym.
CMS (Centers for Medicare and Medicaid Services)
What is the name of the clearinghouse used by UTSW?
Waystar
Which legal term also applies if you want your health insurance provider to take another look at a claim they denied and reconsider (especially if your provider submitted more documentation that showed the services you got were medically needed)?
Appeal
Name the 3 Technical Denials Manager?
Diana Rodriguez
Mary Yow
Tina Hughes
A claim submitted to an insurer might be denied or adjusted. The code that explains the specific reason for the adjustment is a CARC. What does CARC stand for?
Claim Adjustment Reason Code.
What is the acronym for the code set used to report a patient's diagnoses and symptoms?
ICD-10 (International Classification of Diseases)
What is the name of the application utilized by UTSW to view their personal information, such as benefits, payroll information, etc?
PeopleSoft
The revenue cycle begins with which of the following steps?
Who is the President of UTSW?
Dr. Daniel Podolsky
What is the acronym for the coding system used to report medical procedures and services to insurance companies for reimbursement?
CPT (Current Procedural Terminology)
What is the official name of the landmark 2010 health reform law often referred to as "Obamacare"?
The Patient Protection and Affordable Care Act (PPACA).
What is the name of the application to access Standard Operating Procedures?
SOP Library
Patients do not need to be educated on what is covered and what is not considered “medically necessary” because the amount not paid can always be adjusted off the account.
TRUE or FALSE
False