Questions and Answers
What is the purpose of preregistering patients?
What must be verified when establishing financial responsibility?
Patients' eligibility for their health plan
What information is collected during the check-in process for new patients?
Codes for diagnosis and procedures must be assigned during the review of coding compliance.
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What is important to know during the review of billing compliance?
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What typically happens during the check-out process for patients?
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What is the function of preparing and transmitting claims?
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The payer adjudication process judges whether a claim should be paid.
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What happens when payer payments are applied to patient accounts?
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What triggers the collection process for patient accounts?
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Study Notes
Preregister Patients
- Schedule and update appointments for patients before their visit.
- Collect demographics and insurance information for preregistration.
- Gather the medical reason for each appointment.
Establish Financial Responsibility
- Verify patient eligibility for their specific health plan.
- Check coverage details per health plan to determine what services are included.
- Identify the primary payer when multiple health plans are involved.
- Ensure compliance with payers' payment conditions, such as preauthorization prerequisites.
Check in Patients
- For new patients, collect detailed demographic and complete medical information at the front desk.
- For established patients, ask them to review and confirm their information on file.
- Collect copayments during the check-in process.
Review Coding Compliance
- Assign appropriate codes for diagnoses and medical procedures performed.
- Verify that coding is accurate based on the medical file data to uphold compliance.
Review Billing Compliance
- Understand payer guidelines to properly assess what services may be billed through healthcare claims.
Check Out Patients
- Discuss and collect applicable charges from patients at the time of service.
- Typical charges include:
- Previous balance
- Copayments and coinsurance
- Non-covered services
- Charges for nonparticipating providers
- Charges for self-pay patients
- Deductibles
- Schedule any necessary follow-up work as advised by the physician.
Prepare and Transmit Claims
- Create and send claims that contain critical information on diagnoses, procedures performed, and associated charges to payers.
Monitor Payer Adjudication
- Claims undergo a series of evaluation steps by payers to determine payment eligibility and amount.
Generate Patient Statements
- Apply payer payments to the correct patient accounts to reflect balances accurately.
- Bill patients for any remaining amounts due following payment from payers.
Follow Up Payments and Collections
- Regularly analyze patient accounts to identify overdue bills.
- Initiate a collection process for payments that have exceeded allowable time frames.
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Description
This quiz focuses on the 10 essential steps of the revenue cycle in healthcare. Each flashcard presents key terms and their definitions, providing a comprehensive overview for students. Perfect for mastering the foundational concepts of healthcare revenue management.
