CLAIMS REVIEW Flashcards
if corrected prior to billing to third-party payers, they’re easier to correct and result in faster
and more accurate reimbursement
Claim errors and edits
it is an effective method because of consideration for payer variables
Reviewing claims in batches by payer types
What includes claim review?
Verifying details about the :
- patient demographics
- third-party payer attached to the claim
- billing particulars (payer-specific requirements for a
date of injury)
- service codes used
it serves as a focal point of a
claim
determine whether the patient has insurance
coverage
Date of Service (DOS)
are lists of allowed or billed amount for each service in the billing software based on the payer or payer type
Fee schedules
it is when the codes for the referred or ordered services are included as part of the encounter services codes
Abstraction errors
claims with service codes will require this for certain services or procedures
it can be reports of assessments or progress evaluations, or they can be procedure notes
Attachments
it occurs after the pt encounter, documentation completion, and charge capture
significant factor in the revenue cycle
Claim Review Process
When a claim has multiple CPT codes on the same date
of service, they are sequenced in this order to ensure optimal reimbursement
from highest to lowest value
