chapter 4 revenue cycle management Flashcards
ACCEPT ASSIGNMENT
PROVIDER ACCEPTS ASA PAYMENT IN FULL WHATEVER IS PAID ON THE CLAIM BY THE PAYER
ACCOOUNTS RECEIVABLE
THE AMOUNT OWED TO A BUSINESS FOR SERVICES OR GOODS PROVIDED
ACCOUNT RECEIVABLE AGING REPORT
SHOWS THE STAUS OF OUTSTANDING CLAIMS FROM EACH PAYER AS WELL AS PAYMENTS DUE FROM PATIENTS
ACCOUNTS RECEIVABLE MANAGEMENT
ASSUSTS PROVIDERS IN THE COLLECTION OMF APPROPRIATE REIMBURSEMENT FOR SERVIES RENDERED
ALLOWED CHARGES
MAXIMUM AMOUNT THE PAYER WILL REIMBYRSE FOR EACH PROCEDURE OR SERVICE ACCORDING TO THE PATIENTS POLICY
APPEAL
DOCUMENTED AS A LETTER SIGNED BY THE PROVIDER EXPLAINING WHY A CLAIM SHOULD BE RECONSIDERED FOR PAYMENT
ANSI ASC X12N
AN ELECTRONIC FORMAT STANDAR4D THAT USES A VARIABLE LENGTH FILE FORMAT TO PROCCESS TRANSACTIONS FOR INSTITUTIONAL PROFESSIONAL DENTAL AND DRUG CLAIMS
BAD DEBT
ACCOUNTS RECEIVABLE THAT CANNOT BE COLLECTED BY THE PROVIDER OR A COLLECTION AGENCY
ASSIGNMENT OF BENEFITS
THE ORIVIDER RECIVES REIMBURSSEMENT DIRECTLY FROM TEH PAYER
BENEFICIARY
PERSON ELIGIBLE TO RECEIVE HEALTH CARE BENEFITS
BIRTHDAY RULE
DETERMINES COVERAGE BY PROMARY AND SECONDARY POLICIES WHEN EACH PARENT SUBSCRIBES TO A DIFFERENT HEALTH INSURANCE PLAN
CASE MANAGEMENT
DEVELOPMENT OF PATIENT CARE PLANS T COORDINATE AND PROVIDE CARE FOR COMPLICATED CASES IN A COST EFFECTIVE MANNER
CHARE DESCRIPTION MASTER CDM
CHARGEMASTER
CHARGEMASTER
DOCUMENT THAT CONTAINS A COMPUTER GENERATED LIST OF PROCEDURES SERVICES AND SUPPLIES WITH CHARGES FOR EACH CHARGEMASTER DATA ARE ENTERED IN THE FACILITYS PATIENT ACCOUNTING SYSTEM, AND CHARGES ARE AUTOMATICALLYH POSTED TO TEH PATIENTS BILL UB-04
CHARGEMASTER MAINTENANCE
PROCESS OF UPDATING AND REVISING KEY ELEMENTS OF THE CHARGEMASTER TO ENSURE ACCURATE REIMBURSEMENT
CHARGEMASTER TEAM
TEAM OF REPRESENTATIVES FROM A VARIETY OF DEPARTMENTS WHO JOINTLY SHARE RESPONSIBILITY FOR UPDATING AND REVISING THE CHAREGEMASTER TO ENSURE ACCURACY
CLAIMS ADJUDICATION
COMPARING A CLAIM TO PAYER EDUTS THE PATIENTS HEALTH PLAN BENEFITS TO VERIFY THA TEH REQUIRED INFORMATION IS AVAILABLE TO PROCESS TEH CLAIM
CLAIMS ADJUSTMENT REASON CODE CARC
REASON FOR DENIED CLAIM AS REPORTED ON THE REMITTANCE ADVICE OR EOB
CLAIMS ATTACHMENT
MEDICAL REPORT SUBSTANTIATING A MEDICAL CONDITION
CLAIMS DENIAL
UNPAID CLAIM RETURNED BY THIRD PARTY PAYERS BECAUSE OF BENEFICIARY IDENTIFICATION ERRORS CODING ERRORS DIAGNOSIS THAT DOSE NOT SUPPOR TMEDICAL NECCESSITY
CLAIMS PROCESSING
SORTING CLAINS UPON SUBMISSION TO COLLECT AND VERIFY INFORMATION ABOUT THE PATIENT AND PROVIDER
CLAIMS REJECTION
UNPAID CLAIM RETURNE DBY THIRD PARTY PAYERS BECAUSE IT FAILS TO MEET CERTAIN DATA REQUIREMENTS SUCH AS MISSING DATA
CLAIMS SUBMISSION
THE TRANSMISSON OF CLAIMS DATA TO PAYERS OR CLEARINGHOUSES FOR PROCCESSING
CLEAN CLAIM
CORRECTLY COMOLETED STANDARDIZED CLAIM
CLEARINGHOUSE
AGENCY OR ORGANIZATION THAT COLLECTS PROCESSES AND DISTRIBUTS HEALTH CARE CLAIMS AFTER EDITING AND VALIDATING THEM TO ENSURE THAT THEY ARE ERROR FREEE
CLOSED CLAIM
CLAIMS FOR WHICH ALL PROCESSING INCLUDING APPEALS HAS BEEN COMPLETED
COINSURANCE
ALSO CALLE DCOINSURANCED PAYMENT THE PERCENTAGE THE PATIENT PAYS FOR COVERED SERVICES AFTER THE DEDUCTIBLE HAS BEEN MET AND THE COPAYMENT HAS BEEN PAID
COMMON DATA FILE
ABSTRACT OF ALL RECENT CLAIMS FILED ON EACH PATIENT