Managing Claims

Question 1

Name several claim metrics

Answer 1

Claim acceptance rates
Claim Lag
Number of claims submitted
Insurance AR not on claims queue
Pending Claims

Question 2

Define claim acceptance rate

Answer 2

Is the % of claims accepted by the clearing house

Question 3

Where is the claim acceptance rate located?

Answer 3

Claims Reconciliation Report

Question 4

What is the date criteria of the claim acceptance rate?

Answer 4

Weekly

Question 5

What is the target of the claim acceptance rate?

Answer 5

%

Question 6

Define Claim Lag

Answer 6

Is the difference between charge post date and claim acceptance rate

Question 7

Where can you locate the Claim Lag?

Answer 7

The PB Claims Supervisor Dashboard

Question 8

What is the date criteria of the Claim Lag?

Answer 8

Daily

Question 9

What is the target of the Claim Lag?

Answer 9

of days

Question 10

Define Number of Days Submitted

Answer 10

Volume of claims submitted in a given period of time

Question 11

Where can you locate Claims Submitted?

Answer 11

PB Claim Run Tracking report

Question 12

What is the date criteria of claims submitted?

Answer 12

Weekly

Question 13

Claims management and metrics reports to monitor can be located where?

Answer 13

In the Professional Claims Lead Operational Workbook (formerly known as the PB Revenue Cycle Readiness Profile) which may help you identify potential risks to your organization’s revenue cycle

Question 14

Define pending claims

Answer 14

Charges assigned to a payor but not yet submitted on a claim.

Question 15

Where can pending claims be located?

Answer 15

PB Claims Supervisor Dashboard-Pending Claims

Question 16

What is the target amount for pending claims?

Answer 16

Dollar amount

Question 17

Define Insurance AR not a claim queue

Answer 17

AR held up but not included on a claim.
Insurance balance but not a in the claims queue
An end user may change the value of the claim box from {Y] to [N]

Question 18

Where can the mgmt. metric of Claim Lag be located?

Answer 18

The weekly charge post date to claim lag section of the PB Claims supervisor dashboard allows you to monitor the # of days it takes to send out claims. From the charge post date to the claims acceptance date.

Question 19

Where can you locate to report the number of claims submitted over a period of time

Answer 19

Claim Run Tracking Report—(which can be run at the end of the week)–which can be run from the PB Claims Supervisor dashboard.

Question 20

Where can claim volume (which is an operational metric) be located to be reported on?

Answer 20

The Claim Run Tracking Report (from the KPI reports dashboard component there is a drop down from the far right of the claim edit wq productivity report.

Question 21

Define Claim Acceptance Rate

Answer 21

Claims accepted by the clearinghouse

Question 22

Where can you report the Claim Acceptance Rate (2 places)

Answer 22

A report from the clearinghouse
Claim Reconciliation Report (if using CRD)
Target is the % of claims

Question 23

What is the Follow Up WQ Summary Report used for?

Answer 23

Outstanding insurance AR breakdowns and unresolved denial breakdowns. (operational metric)

Question 24

End users can save application reports from which tab?

Answer 24

General

Question 25

My reports are also referred to?

Answer 25

Reporting Workbench