FRONT DOOR SERVICE
The first step in the revenue cycle process for patient and claim elements.
What is the "Front Door"
Is the practice of maintenance and care of health records by traditional and electronic means in physician's office clinics.
Who is Health Information Management (HIM)?
The goal of this initiative is to eliminate "mutually exclusive" code pairings and codes considered to be components of more comprehensive services or otherwise inappropriate to be delivered to the same patient on the same day.
What is National Correct Coding Initiative (NCCI, or more commonly, CCI)
Indicates quality of data collected and reported.
What is a clean claim rate?
This group is responsible for administering Medicare Part A and Part B claims in the state of Texas. They also perform education and audits (probes) to ensure claims integrity
Who is Novitas Solutions?
A process that accelerates cash collections, lowers bad debt, and reduces collection costs.
What is point of service collections (POS)?
Is a medical code set that is used to report medical, surgical, and diagnostic procedures and services to entities such as physicians, health insurance companies and accreditation organizations.
What is a CPT code (Current Procedural Terminology)?
Is a term used to define accounts where the patient has been treated and the account is pending coding, charges, chart documentation or claim holds to be released into a final billed receivable.
What is Pre AR?
This group is assigned to help patients with question, concerns, or billing needs.
Who is Customer Service?
This document is used to notify patients of their financial obligations prior to their services.
What is an estimate?
Is the process of obtaining eligibility, certification or authorization and collecting information from the health plan prior to clinic services.
What is insurance verification?
Is a method used to document diagnoses for patient visits .
What is a ICD10 code (The International Classification of Diseases, Tenth Revision, Clinical Modification)?
These are the maximum units of service that a provider would report under most circumstances for a single beneficiary on a single date of service.
What is Medically Unlikely Edits (MUE)?
This phrase is often used when describing the overall success of collection efforts.
What is "Cash Is King"?
Establishes protocols and policies for reimbursement of health care providers, assures that Medicare and Medicaid are properly administered by third parties, and conducts research and assesses the quality of health care facilities and services.
What is CMS?
A process used to ensure zero payments from the payer are addressed for things like: patient not our insured, missing authorization, missing referral.
What is Denial Management?
These 3 HIM functions ensure coding and billing compliance are maintained.
What is Physician Queries, Coding Audits, Physician Education?
This indicator measures a provider’s ability to comply with payer requirements (authorization, timely filing, etc.) and payer’s ability to accurately pay the claim.
What is Denial Rate?
This indicator measures receivable collectability by payer group. It is an indication of revenue cycle effectiveness at liquidating AR by payer group.
What is Aged A/R as a % of Billed A/R by Payer Group?
This group is dedicated to government oversight (Medicare & Medicaid), combating fraud, waste and abuse and to improving efficiency
Who is Office of Inspector General or OIG?
Who is Clinic Operations?
Is appended to a CPT code to further describe services rendered.
What is a modifier?
This process is responsible for the reconciliation of charges applied to an account and makes sure charges are captured within 3 days after the patient service is rendered.
What is Charge Capture Process?
Is an indicator of a clinic's ability to collect self-pay accounts and identify payer sources for those who cannot meet financial obligations.
What is bad debt?
This act imposes civil and criminal penalty on any doctor, hospital, or supplier who submits an abusive or fraudulent claim for payment to the US government or any third party payer.
What is the False Claims Act?