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Payment Adjudication
H.I.T
| Question | Answer |
|---|---|
| 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
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