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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
GeneDX
GN varied test names developmental, cardiac, genetic and inherited cancers, prenatal and family planning, cardiac arrest in athletes
26
Good Start Genetics
GG Good Start Select carrier testing for genetic conditions
27
Integrated Diagnostics
IN Xpresys Lung lung cancer, blood test for pulmonary modules
28
Pacific Edge
PD CxBladder bladder cancer
29
Progenity
PG nxtPanel, Verifi, Ashkenazi prenatal carrier screening, cystic fibrosis, fragile x, trisonomies
30
Precision Therapeutics
PR ChemoFX, BiospeciFX gynecologic cancer, testing chemo drugs on tumor before patient
31
Prometheus
PL AnserIFX, AnserADA inflammatory bowel; effectiveness of Infliximab & Adalimumab
32
Redpath Integrated Pathology
RI PathfinderTG pancreatic cancer
33
Sequenta
SQ ClonoSIGHT lymphoid malignancies, detection of MRD (minimal residual disease)
34
fully funded plan
traditional; cost-sharing via higher premiums & co-pays
35
2 fully funded advantages
consistent premiums, better for older populations
36
3 fully funded disadvantages
insurance company gets profit, premium is taxed, mandated coverage
37
self funded
employer provides benefits out of own funds, assumes risk for payment, protected under ERISA
38
ERISA
1974 Employee Retirement Income Security Act, sets minimum standards for insurance plans; includes COBRA and HIPAA
39
TPA
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
ASO
Administrative Services Only; branch of traditional insurance company that offers TPA services
41
5 self funded advantages
``` healthy employees = lower premiums lower administrative costs no tax on premium plan design control savings kept by company ```
42
2 self funded disadvantages
catastrophic claims, stop loss insurance is expensive
43
stop loss insurance
covers catastrophic claims on individual (specific) or price ceiling (aggregate) level
44
3 ways to post a receipt
manually from lockbox manually from paper check automatically from lockbox (RemitMax) or direct deposit
45
remit
who paid, what service, when, total charge, discount, amount paid, balance; documents contract info for services rendered and helps provider apply payment
46
ICN
Internal Control Number; aka claim number, used when appeals are needed
47
Patient Account Number synonym in Quadax system
Ticket #
48
Allowed amount formula
allowed = charged - discount
49
patient responsibility
sum of copay, coinsurance, deductible, and out of pocket
50
discount/adjustment
written off, never collected
51
remark/reason code
at least one per charge line, decipher with key at end of remittance
52
contract
agreement between provider and insurance company (fully funded) or TPA and network (self-funded); negotiated rates for every CPT code (based on Medicare)
53
most commonly accessed HARP screen
Inquiry page
54
Inquiry page
account and ticket info, history, messages, billing, transactions
55
3 parts of inquiry screen
patient account summary box, charges, history
56
3 ways to modify a charge
``` 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) ```

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