AND ADJUSTMENTS FROM INSURANCE CARRIERS
(REDUCE PAYMENT DELAY)
VERIFY INSURANCE - answerONE OF THE BEST WAYS TO AVOID PAYMENT
DELAY IS TO DO THIS
(REDUCE PAYMENT DELAY)
SUBMIT CLEAN CLAIMS - answerA CLAIM WITH ALL OF THE INFORMATION
REQUIRED TO BE PROCESSED.
(REDUCE PAYMENT DELAY)
SUBMIT CL...
FEE SCHEDULE - answer✔A LIST OF FEES PHYSICIANS ESTABLISH AS THE FAIR
PRICE FOR THE SERVICES THEY PROVIDE.
DATA ENTRY - answer✔USED FOR: DEMOGRAPHIC INFORMATION, CPT, HCPCS
LEVEL II, AND ICD - 10 - CM CODES TO REPORT THE SERVICES FOR THAT
ENCOUNTER, PAYMENTS AND ADJUSTMENTS FROM INSURANCE CARRIERS
(REDUCE PAYMENT DELAY)
VERIFY INSURANCE - answer✔ONE OF THE BEST WAYS TO AVOID PAYMENT
DELAY IS TO DO THIS
(REDUCE PAYMENT DELAY)
SUBMIT CLEAN CLAIMS - answer✔A CLAIM WITH ALL OF THE INFORMATION
REQUIRED TO BE PROCESSED.
(REDUCE PAYMENT DELAY)
SUBMIT CLAIMS ELECTRONICALLY - answer✔REDUCES CLERICAL PAPERWORK,
COST OF POSTAGE, ENVELOPES, AND FORMS. SUPPLIES THE PRACTICE WITH
REPORTS INDICATING CLAIMS WERE RECEIVED, AND EITHER ACCEPTED OR
REJECTED.
(REDUCE PAYMENT DELAY)
CHECK STATUS REPORTS - answer✔ARE REPORTS SENT FROM THE PAYERS
IDENTIFYING THE STATUS OF THE CLAIMS THAT WERE RECEIVED. THE REPORT
WILL IDENTIFY EACH CLAIM WITH THE PATIENTS' NAMES AND DATE(S) OF
SERVICE AND WHETHER THE CLAIMS WERE ACCEPTED OR REJECTED BY THE
PAYER.
(REDUCE PAYMENT DELAY)
POST CONTRACTUAL ADJUSTMENTS - answer✔A CONTRACTUAL ADJUSTMENT IS
THE AMOUNT THE PROVIDER AGREES TO ACCEPT AS A PARTICIPATING
PROVIDER WITH THE INSURANCE CARRIER.
PRIOR AUTHORIZATION - answer✔A REQUIREMENT THAT A PHYSICIAN OBTAINS
APPROVAL FROM A HEALTH PLAN TO PERFORM A SPECIFIC
SERVICE/PROCEDURE OR PRESCRIBE A SPECIFIC MEDICATION. WITHOUT THIS
PRIOR APPROVAL, THE HEALTH PLAN MAY NOT PROVIDE COVERAGE, OR PAY
FOR THE SERVICE/PROCEDURE OR MEDICATION.
CLAIM SCRUBBERS - answer✔A SOFTWARE PROGRAM THAT REVIEWS CLAIMS
FOR KEY COMPONENTS BEFORE THE CLAIMS ARE SENT TO AN INSURANCE
COMPANY. WILL IDENTIFY POSSIBLE ERRORS BEFORE THE CLAIM IS SUBMITTED.
ACCOUNTS RECEIVABLE OR A/R - answer✔MONEY OWED TO THE PRACTICE FOR
SERVICES RENDERED AND BILLED. PAYMENTS DUE FROM PATIENTS, PAYERS,
OR OTHER GUARANTORS
DAILY DEPOSITS - answer✔WHEN PATIENTS ARE SEEN IN THE OFFICE,
COPAYMENTS, DEDUCTIBLES, COINSURANCE, OR PATIENT BALANCES MAY BE
COLLECTED BY THE OFFICE STAFF. PATIENT PAYMENTS WILL ALSO COME INTO
THE OFFICE BY MAIL, ALONG WITH PAYMENTS FROM INSURANCE COMPANIES
WHERE DIRECT DEPOSIT IS NOT AN OPTION.
DIRECT DEPOSITS - answer✔MANY OF THE INSURANCE PAYERS WILL PAY CLAIMS
WITH DIRECT DEPOSIT. ONCE THE ADJUDICATION PROCESS HAS BEEN
FINALIZED, THE PAYER WILL SEND THE REMITTANCE ADVICE (RA) TO THE
PROVIDER AND AN EXPLANATION OF BENEFITS (EOB) TO THE PATIENT.
ELECTRONIC CLAIMS - answer✔CAN BE SUBMITTED TO A CARRIER FROM A
PROVIDER'S OFFICE USING A COMPUTER WITH SOFTWARE THAT MEETS
ELECTRONIC FILING REQUIREMENTS AS ESTABLISHED BY HIPAA CLAIM
STANDARDS.
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