Overview of Patient Accounting Workqueue Recommendations - Patient Accounting Help Pages (2024)

Work QueueQueue TypeFunctional AreaStaff Role AssignmentQueue Review FrequencyQueue Item Resolution Frequency

Newborn Medicaid Billing(Separate Medicaid Number)

Newborn Medicaid Billing(Same Claim)

Work ItemInsurance BillingInsurance BillerDaily

Weekly

Note

The resolution frequency of this work queue is dependent on the associatedMedicaid policy.

Appeal SubmittedWork ItemDenials & VarianceInsurance Biller

Daily

Weekly

Note

The resolution frequency of this work queue is dependent on payer response timelines.

Contract ReviewWork ItemDenials & VarianceContract Management StaffWeeklyMonthlyContract Variance PostedWork ItemDenials & VarianceInsurance BillerWeeklyMonthlyActive Duty MilitaryWork ItemSelf Pay BillingSelf Pay BillerMonthlyMonthlyNon-Billable Encounter with ChargesWork ItemRevenue IntegrityRevenue Integrity StaffDailyDailyCharge ModificationWork ItemRevenue Integrity

Coder

Clinical Staff

DailyDailyCharge Service Date out of BoundsWork ItemAccount ManagementRevenue Integrity StaffDailyDailyDepartment ReviewWork ItemVariesVariesDaily

Weekly

Note

The resolution frequency of this work queue is dependent on the associated department assignment.

Ambulatory Practice ReviewWork ItemAccount Management

Clinical Manager

Practice Administrator

DailyDailyWork ItemAccount ManagementClinic CoderDailyDailyPhysician Note ReviewWork ItemRevenue IntegrityClinic CoderDaily

Weekly

Note

The resolution frequency of this work queue is dependent on the associated department assignment.

Professional Coding - AnesthesiaWork ItemProfessional CodingClinic CoderDailyDailyProfessional Coding - Invasive and Noninvasive CardiologyWork ItemProfessional CodingClinic CoderDailyDailyProfessional Coding - SurgeryWork ItemProfessional CodingClinic CoderDailyDailyProfessional Coding - Women's HealthWork ItemProfessional CodingClinic CoderDailyDailyPending MedicaidWork ItemAccount ManagementFinancial CounselorDaily

Weekly

Note

The resolution frequency of this work queue is dependent on Medicaid response times.

Perioperative Implant BillingWork ItemRevenue Integrity

Biller

Perioperative Services Department

DailyDailyRecurring Health Plan ChangeWork ItemAccount ManagementInsurance BillerDailyDailyRegistration Review RequiredWork ItemAccount ManagementRegistrarDailyDailyResearch Patient Episode of Care ReviewWork ItemNon-Patient AR

Research Coordinator

Revenue Integrity Staff

See Also
Using CPDI Work Queue Monitor - Oracle Health Document Imaging Help PagesConfiguring a Work Queue in CPDI Work Queue Manager - Oracle Health Document Imaging Help PagesManage Unknown Queue in Work Queue Monitor (WQM)

DailyDailyPrepayment Review - Women's HealthWork ItemSelf Pay BillingSelf Pay BillerDailyWeeklyWH Medicaid BillingWork ItemInsurance BillingInsurance BillerDailyDailyMonthly Hard CloseWork ItemRevenue IntegrityBusiness Office ManagerMonthly

Weekly

Note

The resolution frequency of this work queue is dependent on the local hard close date.

Timely FilingWork ItemInsurance BillingInsurance BillerDaily

Weekly

Note

The resolution frequency of this work queue is dependent on the timely filling notification date.

Bankruptcy Pending ReviewWork ItemSelf Pay BillingSelf Pay BillerWeeklyWeeklyPending Financial AssistanceWork ItemSelf Pay Billing

Financial Counselor

Business Office Supervisor or Manager

Daily

Monthly

Note

The resolution frequency of this work queue is dependent on patient response times.

Self Pay After MedicaidWork ItemSelf Pay BillingSelf Pay BillerDailyWeeklyManager Refund ResolutionWork ItemTransaction PostingBusiness Office ManagerDailyDailyMedically Related - Combine EncountersWork ItemInsurance BillingInsurance BillerDailyDailyMedically Related AssessmentWork ItemInsurance BillingCoderDailyWeeklyNot Medically Related - Move ChargesWork ItemInsurance BillingInsurance BillerDailyDailySupervisor Refund ResolutionWork ItemTransaction PostingBusiness Office SupervisorDailyDailyHIM Interim Dx RequestWork ItemRevenue IntegrityCoderDailyDailyHIM Medical Records ReqWork ItemRevenue Integrity

Medical Records Department

ROI Department

DailyDailyHIM: Coding - Holding for Dept/CathLabWork ItemRevenue IntegrityClinical Staff (Cath Lab)DailyDailyHIM: Coding - Holding for Dept/EDWork ItemRevenue IntegrityClinical Staff (ED)DailyDailyHIM: Coding - Holding for Dept/LabWork ItemRevenue IntegrityClinical Staff (Lab)DailyDailyHIM: Coding - Holding for Dept/RadiologyWork ItemRevenue IntegrityClinical Staff (Radiology)DailyDailyHIM: Coding - Holding for Dept/Rev IntegrityWork ItemRevenue IntegrityRevenue Integrity StaffDailyDailyHIM: Coding - Holding for Dept/SurgeryWork ItemRevenue IntegrityClinical Staff (Surgery)DailyDailyRefer to HIM: Multiple Primary Carve OutWork ItemRevenue IntegrityCoderDailyDailyRefer to HIM: Recurring Health Plan ChangeWork ItemRevenue IntegrityCoderDailyDailyTechnical Denial - Additional Info NeededWork ItemDenials & VarianceInsurance Follow-up RepresentativeDaily

Weekly

Note

The resolution frequency of this work queue varies.

Technical Denial - BenefitsWork ItemDenials & VarianceInsurance Follow-up RepresentativeDaily

Weekly

Note

The resolution frequency of this work queue varies.

Technical Denial - Billing Submission ErrorsWork ItemDenials & Variance

Insurance Follow-up Representative

Self-Pay Biller

Daily

Weekly

Note

The resolution frequency of this work queue varies.

Technical Denial - Case ManagementWork ItemDenials & Variance

Insurance Follow- up Representative

Case Manager

Daily

Weekly

Note

The resolution frequency of this work queue varies.

Technical Denial - CodingWork ItemDenials & Variance

Insurance Follow-up Representative

Coder

Daily

Weekly

Note

The resolution frequency of this work queue varies.

Technical Denial - Medical NecessityWork ItemDenials & VarianceInsurance Follow-up RepresentativeDaily

Weekly

Note

The resolution frequency of this work queue varies.

Technical Denial - OtherWork ItemDenials & VarianceInsurance Follow-up RepresentativeDaily

Weekly

Note

The resolution frequency of this work queue varies.

Technical Denial - Provider/Physician Follow-upWork ItemDenials & VarianceInsurance Follow-up RepresentativeDaily

Weekly

Note

The resolution frequency of this work queue varies.

Technical Denial - Registration/EligibilityWork ItemDenials & Variance

Insurance Follow- up Representative

Registrar

Daily

Weekly

Note

The resolution frequency of this work queue varies.

Technical Denial - ReimbursementWork ItemDenials & VarianceInsurance Follow-up RepresentativeDaily

Weekly

Note

The resolution frequency of this work queue varies.

Technical Denial Review RequiredWork ItemDenials & VarianceVariesDaily

Weekly

Note

The resolution frequency of this work queue varies.

OCE Lab Edits: 80048

Work ItemRevenue IntegrityLab DepartmentDailyDailyOCE Lab Edits: 80051Work ItemRevenue IntegrityLab DepartmentDailyDailyOCE Lab Edits: 80053Work ItemRevenue IntegrityLab DepartmentDailyDailyOCE Lab Edits: 80069Work ItemRevenue IntegrityLab DepartmentDailyDailyOCE Lab Edits:80076Work ItemRevenue IntegrityLab DepartmentDailyDailyOCE Lab Edits: 81003Work ItemRevenue IntegrityLab DepartmentDailyDailyOCE Lab Edits: 82575Work ItemRevenue IntegrityLab DepartmentDailyDailyOCE Lab Edits: 82945Work ItemRevenue IntegrityLab DepartmentDailyDailyOCE Lab Edits: 84160Work ItemRevenue IntegrityLab DepartmentDailyDailyOCE Lab Edits: 85025Work ItemRevenue IntegrityLab DepartmentDailyDailyOCE Lab Edits: 86141Work ItemRevenue IntegrityLab DepartmentDailyDailyCase Management Adjustment OrderWork ItemRevenue IntegrityCase ManagerDailyDailyCase Management Review RequiredWork ItemInsurance BillingCase ManagerDailyDailyCase Management Status ReviewWork ItemInsurance BillingCase ManagerWeeklyWeeklyPossible Two MidnightWork ItemInsurance BillingCase ManagerDailyDailyIME Pending EditsWork ItemInsurance BillingInsurance BillerDailyDaily835 File FailureWork ItemTransaction PostingIT DepartmentDailyDailyTransaction Batch DeniedWork ItemTransaction Posting

Insurance Biller

Self-Pay Biller

DailyDailyEmployee Payroll DeductionWork ItemSelf-Pay BillingSelf-Pay BillerDailyDailyEncounters Without ChargesWork ItemRevenue IntegrityBack Office StaffDailyWeeklyFinancial Assistance AdjustmentWork ItemSelf-Pay BillingFinancial CounselorDailyDailyFinancial Assistance ReviewWork ItemSelf-Pay Billing
Daily

Daily

Note

This frequency applies only to outpatient encounters.

Patient DeceasedWork ItemSelf-Pay BillingSelf-Pay BillerWeeklyWeeklyGlobal Billing WorkflowsWork ItemInsurance BillingInsurance BillerDailyDailyReturn from Collections - Bill InsuranceWork ItemInsurance BillingBusiness Office Supervisor or ManagerDailyDailyReturn from Collections - OtherWork ItemInsurance BillingBusiness Office Supervisor or ManagerDailyWeeklyReturn from Collections - UncollectibleWork ItemInsurance BillingBusiness Office Supervisor or ManagerDailyWeeklySelf Pay Late Charge ReviewWork ItemSelf-Pay BillingSelf-Pay BillerDailyWeeklyProvider Liable - No PayWork ItemInsurance BillingInsurance BillerDailyDailyMultiple Primary - Carve OutWork ItemInsurance BillingInsurance BillerDailyDailyRecurring Credit Card DeclinedWork ItemSelf-Pay BillingSelf-Pay Biller or Follow-up RepresentativeDaily

Weekly

Note

The resolution frequency of this work queue is dependent on patient response times.

Recurring Credit Card FailureWork ItemSelf-Pay BillingSelf-Pay Biller or Follow-up RepresentativeDaily

Weekly

Note

The resolution frequency of this work queue is dependent on patient response times.

Edit Failure Work ItemWork ItemInsurance BillingInsurance BillerDailyDailyInfusion and InjectionWork Item

Revenue Integrity

Coder

Revenue Integrity Staff

DailyDailyReturned MailWork ItemSelf-Pay BillingSelf-Pay Follow-up RepresentativeDaily

Weekly

Note

The resolution frequency of this work queue is dependent on patient response times.

Room and Bed and Length of Stay MismatchWork ItemRevenue IntegrityRevenue Integrity StaffDailyDailyTrauma Team ResponseWork ItemRevenue Integrity

ED Biller

Coder

DailyDailyVoided Benefit OrderWork ItemAccount ManagementInsurance BillerDailyDailyWorkers Comp Statement HoldWork ItemSelf-Pay BillingSelf-Pay BillerDailyDaily
Overview of Patient Accounting Workqueue Recommendations - Patient Accounting Help Pages (2024)

FAQs

What is the patient accounting? ›

Patient accounting deals specifically with each individual patient. This includes the services they received, medicines and other items used in their care, and the bills generated. It also includes tracking payments from patients, insurance companies, and third parties like charities.

Get More Info ›
What is patient accounting experience? ›

As a patient account specialist, your job duties include researching records and payer information, explaining payment policies for healthcare services, and identifying payment sources and insurance policies. You may also answer patient questions and maintain updated electronic medical records.

Read The Full Story ›
What is another name for the patient accounting software? ›

Patient accounting software is referred to as a practice management system (PMS).

Keep Reading ›
How does healthcare accounting impact the patients? ›

By dealing with insurance companies effectively, financial accounting in healthcare can ease the payment process, making it more manageable for patients. This delicate dance helps in minimizing patients' financial burdens and maximizing reimbursement.

Read The Full Story ›
What is the patient account summary? ›

Account summary: The box found in the lower right of patient bills showing the total charges for your visit, payments received and adjustments made, your current account balance and payment due date.

Tell Me More ›
What are the two types of accounting in healthcare? ›

There are two types of accounting that your medical group can use to track revenues and expenses: accrual accounting or cash-basis accounting.

See More ›
What does a patient accounting associate do? ›

A patient account representative works directly with patients to help manage questions and resolve issues regarding billing and collection. Your duties include communicating with individuals and insurance companies to provide information, handle complaints, and inquire about claims.

Learn More ›
What is the difference between EHR and patient accounting system? ›

Both systems can store patient data, but there's a difference in the type of data each system handles. In the simplest terms: An EHR system stores clinical data that can be shared with other providers. A PMS stores insurance, payment, and contact information.

Discover More ›
Which accounting software is used by hospitals? ›

Our features and flexible add-on modules make Sage Intacct the best healthcare accounting software to further automate and streamline processes.

Read The Full Story ›
How is accounting done in the hospital? ›

Hospital accounting covers everything that goes into a hospital's income statement and balance sheet. That includes patient revenues, additional services like parking, expenses like rent and supplies, and salaries for hospital staff.

Read The Full Story ›

What is patient accounting? ›

Patient accounting deals with calculating and producing patient billing information, and hospital accounting deals with the hospital's bills and finances.

Read On ›
What makes healthcare accounting unique? ›

Healthcare accounting focuses on the collection and reporting of financial records related to healthcare practices. Financial statements provide an accurate picture of what you are spending your money on. Additionally, they allow you as a business owner to make more informed decisions.

Get More Info Here ›
What is accounting with an example? ›

Accounting is the process of recording financial transactions pertaining to a business. The accounting process includes summarising, analysing, and reporting these transactions to oversight agencies, regulators, and tax collection entities.

Show Me More ›
What is required on patient account record? ›

Typical medical records include: Patient identification, contact information, and date of birth. Billing and health insurance details. List of current and chronic ailments and diagnoses.

Keep Reading ›
What does a patient account specialist do? ›

Patient Account Representatives compile, process, and maintain medical records of hospital and clinic patients in a manner consistent with medical, administrative, ethical, legal, and regulatory requirements of the healthcare system.

Learn More ›

References

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