Save
Busy. Please wait.
Log in using Clever
or

show password
Forgot Password?

Don't have an account?  Sign up 
Sign up using Clever
or

Username is available taken
show password

why


Make sure to remember your password. If you forget it there is no way for StudyStack to send you a reset link. You would need to create a new account.
Your email address is only used to allow you to reset your password. See our Privacy Policy and Terms of Service.


Already a StudyStack user? Log In

Reset Password
Enter the associated with your account, and we'll email you a link to reset your password.
focusNode
Didn't know it?
click below
 
Knew it?
click below
Don't know
Remaining cards (0)
Know
0:00
share
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.

  Normal Size     Small Size show me how

Payment Adjudication

H.I.T

QuestionAnswer
what happens after the claim is submitted? the third-party payer or health insurer, is reviewing the claim
accounts receivable department department that keeps track of what third party payers the provider is waiting to hear from & what pts are due to make a payment
what is the primary purpose of CDM? to make sure the provider accurately charges the pt for routine services & supplies
aging report measures the outstanding balances in each account
how are aging reports maintained? in 30 day increments
why are aging reports useful? they help the office staff see which accounts have not been paid
Remittance Advice report sent from the 3rd party payers to the provider
where is the EOB sent? sent to the policyholder
medicare summary notice (MSN) document that outlines the amts billed by the provider & what the pt must pay the provider
what does is mean when physicians accept assignment? the health care professional accepts as payment in full Medicare's allowable charge
what's another name for posting payments? reconciliation & collections
group codes identify the party financially responsible for a specific service or the general category of payment adjustment
claims adjustment reason codes (CARCs) provide financial info about claims decisions
remittance advice remark codes (RARCs) further explain reason for a payment adjustment
provider-level adjustment reason codes are not related to a specific claim. These adjustments are made by the provider's office
affordable care act(ACA) is how pts can appeal health ins decisions
who benefits from the appeals process? the pt
when can a pt request an external independent review? if the claim is still denied
Created by: diasiar
 

 



Voices

Use these flashcards to help memorize information. Look at the large card and try to recall what is on the other side. Then click the card to flip it. If you knew the answer, click the green Know box. Otherwise, click the red Don't know box.

When you've placed seven or more cards in the Don't know box, click "retry" to try those cards again.

If you've accidentally put the card in the wrong box, just click on the card to take it out of the box.

You can also use your keyboard to move the cards as follows:

If you are logged in to your account, this website will remember which cards you know and don't know so that they are in the same box the next time you log in.

When you need a break, try one of the other activities listed below the flashcards like Matching, Snowman, or Hungry Bug. Although it may feel like you're playing a game, your brain is still making more connections with the information to help you out.

To see how well you know the information, try the Quiz or Test activity.

Pass complete!

"Know" box contains:
Time elapsed:
Retries:
restart all cards