Your first week in healthcare admin

Key facts · Part 1 Essentials

• Provider vs. payer: the hospital gives care, someone else pays
• E-H-R: the digital chart where everything you do is logged
• HIPAA: patient privacy, and only access the minimum necessary
• R-C-M: the money journey from scheduling to final payment
• C-P-T is what was done; I-C-D ten is why it was done
• Prior auth: the payer's advance approval before certain care

Key facts · Part 2 Deeper

• Medicare is for people sixty-five and older and some people with disabilities. Part A is hospital, Part B is outpatient and physician care.
• Medicaid is state and federal for low income, and rules vary by state.
• H-M-O requires a primary care doctor and referrals. P-P-O gives more freedom. Network status sets the contracted rate.
• A denial is a payer refusing to pay. Soft denials can be fixed and resubmitted. Hard denials mean no payment.
• Medical coders assign C-P-T and I-C-D ten codes from the documentation.
• Financial counselors help patients with charity care, Medicaid enrollment, and payment plans.
• Most denials start at the front end, so accuracy early is cheaper than appealing later.

Key facts · Part 3 Drill

• The hospital provides care and a payer pays for it; admin work makes that happen accurately
• Everything in the E-H-R is logged, and HIPAA means only the minimum necessary
• C-P-T is what was done; I-C-D ten is why it was done
• Prior auth is the payer's advance approval before care; without it, expect a denial
• Most denials start at the front end, so accuracy early is cheaper than appealing later