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Core Training > Week 3 > Flashcards

Week 3 Flashcards

1
Q

Retention rate of EDI

A

95%

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2
Q

CMx

A

Claims Management; EDI edit engine with Xpressbiller, claim tracking record, ID and workflow for front-end rejections

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3
Q

RMx

A

Remittance Management; EDI data management tool, standard EOBs, ASP

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4
Q

ASP

A

Automated Secondary Processing - no manual intervention needed for secondary claim

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5
Q

DMx

A

Denial Management; follow-up, prevent, and report on denials; hosted

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6
Q

ELx

A

Eligibility for EDI; validate insurance, demographics, coverage, copay & deductible; real-time automated batching on back end

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7
Q

CSx

A

Claim Status for EDI; 276 is request for status update, 277 is response; eliminates time on phone with insurance

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8
Q

ACx

A

Audit Control for EDI; managing all types of audits with Axis

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9
Q

Axis

A

workflow, tracking and reporting for audits

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10
Q

MCx

A

Medicare Connection for EDI; verifies eligibility and liability; FISS interactivity

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11
Q

ADR

A

Additional Development Request; EDI; if claim selected for medical review, documentation is requested to verify correct payment was applied

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12
Q

EDG

A

conduit between clients, payers, and Quadax EDI; not compliance; maintains edits to reduce front-end rejections

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13
Q

EDG purpose

A

verify, clarify, simplify

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14
Q

EDG principles

A

CPT - convergence, partnership, transparency

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15
Q

Table-driven edits

A

EDG edits that reference code tables to verify claim validity

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16
Q

Hard-coded edits

A

EDG edits that use Quadax-proprietary QuickScript edits

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17
Q

Ariosa

A

AR
Harmony
Prenatal trisonomy testing

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18
Q

Biodesix

A

BX
Veristrat
non-small cell lung cancer for patients who have had chemo; will they benefit from Erlotnib?

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19
Q

Castle Biosciences

A

CK
DecisionDX
glioblastoma, uveal melanoma, thymus, melanoma, esphageal

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20
Q

Courtagen Life Sciences

A

CG
SEEK
metabolic (mitochondrial) and neurological disorders

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21
Q

Genomind

A

RG
Genecept
mental health disorders and how your body will respond to certain drugs

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22
Q

Exagen Diagnostics

A

EX
Avise
rheumatoid arthritis & lupus

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23
Q

Foundation Medicine

A

FM
FoundationOne
genomic testing for personalized cancer treatment; alternations in solid tumors; hematologic malignancies

24
Q

Genomic Health

A

GO
OncotypeDX, DCIS, MMR
breast, colon, prostate cancer; recurrence score (breast), gleason score (prostate)

25
Q

GeneDX

A

GN
varied test names
developmental, cardiac, genetic and inherited cancers, prenatal and family planning, cardiac arrest in athletes

26
Q

Good Start Genetics

A

GG
Good Start Select
carrier testing for genetic conditions

27
Q

Integrated Diagnostics

A

IN
Xpresys Lung
lung cancer, blood test for pulmonary modules

28
Q

Pacific Edge

A

PD
CxBladder
bladder cancer

29
Q

Progenity

A

PG
nxtPanel, Verifi, Ashkenazi
prenatal carrier screening, cystic fibrosis, fragile x, trisonomies

30
Q

Precision Therapeutics

A

PR
ChemoFX, BiospeciFX
gynecologic cancer, testing chemo drugs on tumor before patient

31
Q

Prometheus

A

PL
AnserIFX, AnserADA
inflammatory bowel; effectiveness of Infliximab & Adalimumab

32
Q

Redpath Integrated Pathology

A

RI
PathfinderTG
pancreatic cancer

33
Q

Sequenta

A

SQ
ClonoSIGHT
lymphoid malignancies, detection of MRD (minimal residual disease)

34
Q

fully funded plan

A

traditional; cost-sharing via higher premiums & co-pays

35
Q

2 fully funded advantages

A

consistent premiums, better for older populations

36
Q

3 fully funded disadvantages

A

insurance company gets profit, premium is taxed, mandated coverage

37
Q

self funded

A

employer provides benefits out of own funds, assumes risk for payment, protected under ERISA

38
Q

ERISA

A

1974 Employee Retirement Income Security Act, sets minimum standards for insurance plans; includes COBRA and HIPAA

39
Q

TPA

A

Third Party Administrator; adjudicates and pays claims with funds collected from employer; contracts with network to give subscribers access to providers; sends out EOB and EOP

40
Q

ASO

A

Administrative Services Only; branch of traditional insurance company that offers TPA services

41
Q

5 self funded advantages

A 
healthy employees = lower premiums
lower administrative costs
no tax on premium
plan design control
savings kept by company
42
Q

2 self funded disadvantages

A

catastrophic claims, stop loss insurance is expensive

43
Q

stop loss insurance

A

covers catastrophic claims on individual (specific) or price ceiling (aggregate) level

44
Q

3 ways to post a receipt

A

manually from lockbox
manually from paper check
automatically from lockbox (RemitMax) or direct deposit

45
Q

remit

A

who paid, what service, when, total charge, discount, amount paid, balance; documents contract info for services rendered and helps provider apply payment

46
Q

ICN

A

Internal Control Number; aka claim number, used when appeals are needed

47
Q

Patient Account Number synonym in Quadax system

A

Ticket #

48
Q

Allowed amount formula

A

allowed = charged - discount

49
Q

patient responsibility

A

sum of copay, coinsurance, deductible, and out of pocket

50
Q

discount/adjustment

A

written off, never collected

51
Q

remark/reason code

A

at least one per charge line, decipher with key at end of remittance

52
Q

contract

A

agreement between provider and insurance company (fully funded) or TPA and network (self-funded); negotiated rates for every CPT code (based on Medicare)

53
Q

most commonly accessed HARP screen

A

Inquiry page

54
Q

Inquiry page

A

account and ticket info, history, messages, billing, transactions

55
Q

3 parts of inquiry screen

A

patient account summary box, charges, history

56
Q

3 ways to modify a charge

A 
before finishing a ticket (go back and make changes)
before balancing (open ticket from batch and make changes)
after balancing (use CIE System to remove charge)

Core Training (4 decks)

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