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medicial billing and coding > chapter 4 revenue cycle management > Flashcards

chapter 4 revenue cycle management Flashcards

1
Q

ACCEPT ASSIGNMENT

A

PROVIDER ACCEPTS ASA PAYMENT IN FULL WHATEVER IS PAID ON THE CLAIM BY THE PAYER

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2
Q

ACCOOUNTS RECEIVABLE

A

THE AMOUNT OWED TO A BUSINESS FOR SERVICES OR GOODS PROVIDED

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3
Q

ACCOUNT RECEIVABLE AGING REPORT

A

SHOWS THE STAUS OF OUTSTANDING CLAIMS FROM EACH PAYER AS WELL AS PAYMENTS DUE FROM PATIENTS

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4
Q

ACCOUNTS RECEIVABLE MANAGEMENT

A

ASSUSTS PROVIDERS IN THE COLLECTION OMF APPROPRIATE REIMBURSEMENT FOR SERVIES RENDERED

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5
Q

ALLOWED CHARGES

A

MAXIMUM AMOUNT THE PAYER WILL REIMBYRSE FOR EACH PROCEDURE OR SERVICE ACCORDING TO THE PATIENTS POLICY

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6
Q

APPEAL

A

DOCUMENTED AS A LETTER SIGNED BY THE PROVIDER EXPLAINING WHY A CLAIM SHOULD BE RECONSIDERED FOR PAYMENT

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6
Q

ANSI ASC X12N

A

AN ELECTRONIC FORMAT STANDAR4D THAT USES A VARIABLE LENGTH FILE FORMAT TO PROCCESS TRANSACTIONS FOR INSTITUTIONAL PROFESSIONAL DENTAL AND DRUG CLAIMS

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7
Q

BAD DEBT

A

ACCOUNTS RECEIVABLE THAT CANNOT BE COLLECTED BY THE PROVIDER OR A COLLECTION AGENCY

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7
Q

ASSIGNMENT OF BENEFITS

A

THE ORIVIDER RECIVES REIMBURSSEMENT DIRECTLY FROM TEH PAYER

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8
Q

BENEFICIARY

A

PERSON ELIGIBLE TO RECEIVE HEALTH CARE BENEFITS

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9
Q

BIRTHDAY RULE

A

DETERMINES COVERAGE BY PROMARY AND SECONDARY POLICIES WHEN EACH PARENT SUBSCRIBES TO A DIFFERENT HEALTH INSURANCE PLAN

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10
Q

CASE MANAGEMENT

A

DEVELOPMENT OF PATIENT CARE PLANS T COORDINATE AND PROVIDE CARE FOR COMPLICATED CASES IN A COST EFFECTIVE MANNER

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11
Q

CHARE DESCRIPTION MASTER CDM

A

CHARGEMASTER

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12
Q

CHARGEMASTER

A

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

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13
Q

CHARGEMASTER MAINTENANCE

A

PROCESS OF UPDATING AND REVISING KEY ELEMENTS OF THE CHARGEMASTER TO ENSURE ACCURATE REIMBURSEMENT

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14
Q

CHARGEMASTER TEAM

A

TEAM OF REPRESENTATIVES FROM A VARIETY OF DEPARTMENTS WHO JOINTLY SHARE RESPONSIBILITY FOR UPDATING AND REVISING THE CHAREGEMASTER TO ENSURE ACCURACY

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15
Q

CLAIMS ADJUDICATION

A

COMPARING A CLAIM TO PAYER EDUTS THE PATIENTS HEALTH PLAN BENEFITS TO VERIFY THA TEH REQUIRED INFORMATION IS AVAILABLE TO PROCESS TEH CLAIM

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16
Q

CLAIMS ADJUSTMENT REASON CODE CARC

A

REASON FOR DENIED CLAIM AS REPORTED ON THE REMITTANCE ADVICE OR EOB

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17
Q

CLAIMS ATTACHMENT

A

MEDICAL REPORT SUBSTANTIATING A MEDICAL CONDITION

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18
Q

CLAIMS DENIAL

A

UNPAID CLAIM RETURNED BY THIRD PARTY PAYERS BECAUSE OF BENEFICIARY IDENTIFICATION ERRORS CODING ERRORS DIAGNOSIS THAT DOSE NOT SUPPOR TMEDICAL NECCESSITY

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19
Q

CLAIMS PROCESSING

A

SORTING CLAINS UPON SUBMISSION TO COLLECT AND VERIFY INFORMATION ABOUT THE PATIENT AND PROVIDER

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20
Q

CLAIMS REJECTION

A

UNPAID CLAIM RETURNE DBY THIRD PARTY PAYERS BECAUSE IT FAILS TO MEET CERTAIN DATA REQUIREMENTS SUCH AS MISSING DATA

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21
Q

CLAIMS SUBMISSION

A

THE TRANSMISSON OF CLAIMS DATA TO PAYERS OR CLEARINGHOUSES FOR PROCCESSING

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22
Q

CLEAN CLAIM

A

CORRECTLY COMOLETED STANDARDIZED CLAIM

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23
Q

CLEARINGHOUSE

A

AGENCY OR ORGANIZATION THAT COLLECTS PROCESSES AND DISTRIBUTS HEALTH CARE CLAIMS AFTER EDITING AND VALIDATING THEM TO ENSURE THAT THEY ARE ERROR FREEE

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24
Q

CLOSED CLAIM

A

CLAIMS FOR WHICH ALL PROCESSING INCLUDING APPEALS HAS BEEN COMPLETED

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25
Q

COINSURANCE

A

ALSO CALLE DCOINSURANCED PAYMENT THE PERCENTAGE THE PATIENT PAYS FOR COVERED SERVICES AFTER THE DEDUCTIBLE HAS BEEN MET AND THE COPAYMENT HAS BEEN PAID

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26
Q

COMMON DATA FILE

A

ABSTRACT OF ALL RECENT CLAIMS FILED ON EACH PATIENT

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27
Q

CONCURRENT REVIEW

A

REVIEW FOR MEDICAL NECCESSITY OF TEST AND PROCEDURES ORDERED DURING AN INPATIENT HOSPITALIZATION

28
Q

CONSUMER CREDIT PROTECTION ACT OF 1968`

A

WAS CONSIDERED LANDMARK LEGISLATION BECAUSE IT LAUNCHED TRUTH IN LENDING DISCLOSURED THAT REQUIRED CREDITORS TO COMMUNICATE THE COST OF BORRIWUBG MONEY IN A COMMON LANGUAGE SO HA TCONSUMERS COULD FIGURE OUT THE CHARGES COMPARE COST AND SHOP FOR THE BEST CREDIT DEAL

29
Q

COORDINATION OF BENEFITS COB

A

PROVISION IN GROUP HEALTH INSURANCE POLICIES THAT PREVENTS MULTIPLE INSURERS FROM PAYING BEEFITS COVERED BY OTHER POLICIES

30
Q

COVERED ENTITY

A

PRIVATE SECTOR HEALTH PLANS MANAGED CARE ORGANIZATIONS COVERD HEALTH BEEFIT PLANS AND GOVERNMENT HEALTH PLANS

31
Q

DATA ANALYTICS

A

TOOLS AND SYSTEMS THAT ARE USED OT ANALYZE CLINICLA AND FINANCIAL DATA

32
Q

DATA MINING

A

EXTRACTING AND ANALYZING DATA TO IDENTIFY PATTERNS

33
Q

DATA WAREHOUSE

A

DATABASE THAT USE REPORTIN GINTERFACES TO CONSIOLIDATE MUTIPLE DATABASES ALLOWING REPORTS TO BE GENERATED FORM A SINGLE REQUEST

34
Q

DAY SHEET

A

ACCOUNTS RECEIVABLE JOURNAL CHRONOLGIVALO SUMMARY OF ALL TRANSACTIONS POSTED TO INDIVIDUAL PATIENT LEDGERS ACCOUNTS ON A SPECIFIC DAY

35
Q

DEDUCTIBLE

A

AMOUNT FOR WHICH THE PATIENT IS FINACIALLY RESPONSIBLE BEFORE AN INSURANCE POLICY PROVIDES COVERAGE

36
Q

DELINQUENT ACCOUNT

A

PAST DUE ACCOUNT

37
Q

DELINQUENT CLAIM

A

CLAIM USUALLY MARE THAN 120 DAYS PAST DUE

38
Q

DELINQUENT CLAIM CYCLE

A

ADVANCE THROUGH VARIOUS AGING PERIODS WITH PRACTICES TYPICALLY FOCUSING INTERNAL RECOVERY EFFORTS ON OLDER DELINQUENT ACCOUNTS

39
Q

DENINED CLAIM

A

CLAIM RETURNED TO THE PROVIDER BY PAYERS DUE TO CODING ERRORS

40
Q

DISCHARGE PLANNING

A

INCOLVES ARRANGING APPROPRIATE HEALHT CARE SERVICES FOR THE DISCHARGED PATIENT

41
Q

DOWNCODING

A

ASSIGNING LOWER LEVEL CODES THAN DOCUMENTED IN THE RECORD

42
Q

ELECTRONIC DATA INTERCHANGE EDI

A

COMPUTER TO COMPUTER EXCHANGE OF DATA BETWEEN PROVIDER AND PAYER

43
Q

ELECTRONIC FLAT FILE FORMAT

A

SERIES OF FIXE DLENGTH RECORDS

44
Q

ELECTRONIC FUNDS TRANSFER EFT

A

SYSTEM BY WHICH PAYERS DEPOSIT FUNDS TO THE PROVIDERS ACCOUNT ELECTRONICALLY

45
Q

ELECTRONIC FUNDS TRANSFER ACT

A

ESTABLISHED THE RIGHTS LIABILITIES AND RESPONSIBILITIES OF PARTICIPANTS IN ELECTRONIC FUNDS TRANSFER SYSTEM

46
Q

ELECTRONIC HEALTHCARE NETWORK ACCREDITATION COMMISSON EHNAC

A

ORGANIZATION THAT ACCREDITS CLEARINGHOUSES

47
Q

ELECTRONIC MEDIA CLAIM

A

ELECTRONIC FLAT FILE FORMAT

48
Q

ELECTRONIC REMITTANCE ADVICE ERA

A

REMITTANCE ADVICE THAT IS SUBMITTED TO ATHE PROVIDER ELECTRONICALLLY AND CONTAINS THE SAME INFORMATION AS A PAPER BASE DREMITTANCE ADVICE

49
Q

ENCOUNTER FORM

A

FINANCIAL RECORD SOURCE DOCUMENT USED BY PROVIDERS AND OTHER PERSONNEL TO RECORD TREATED DIAGNOSES AND SERVICES RENDERED TO TEH PATIENT DURING THE CURRENT ENCOUNTER

50
Q

EQUAL CREDIT OPPORTUNITY ACT

A

PROHIBITS DISCTIMINATION ON THE BASIC OF RACE COLOR RELIGION NATHIONAL ORIGIN SEX MARITAL STATUS AGE

51
Q

FAIR CREDIT AND CHAREGE CARD DISCLOSURE ACT

A

AMENDED THE TRUTH IN LENDING ACT REQUIRUNG CREDIT AND CHAREG CARD ISSURES TO PROVIDE CERTAIN DISCLOSURES IN DIRECT MAIL TELEPHONE

52
Q

FAOR CREDIT BILLING ACT

A

THAT HELPS CONSUMERS RESOLVE BILLING ISSUES WITH CARD ISSUERS PROTECTS IMPORTANT CREDIT RIGHTS

53
Q

FAIR CREDIT REPORTING ACT

A

PROTECTS INFORMATION COLLEFCTED BY CONSUMER REPORTING AGENCIE SSUCH AS CREDIT DUREAUS

54
Q

FAIR DEBT COLLECTION P0RACTICES ACT FDCPA

A

SPECIFIES WHAT A COLLECTION SOURCE MAY AND MAY NOT DO WHEN PURSURING PAYMENT OF PAST DUE ACCOUNTS

55
Q

GUARANTOR

A

PEROSON RESPONSIBLE FOR PAYING HEALTH CARE FEES

56
Q

INTEGRATED REVENUE CYCLE IRC

A

COMBINING REEVENUE CYLCE MANAGEMENT WITH CLINICAK CODING AND INFORMATION MANAGEMENT DECISIONS BECAUSE OF THE IMPACT ON FINANCIAL MANAGEMENT

57
Q

LITITGATION

A

LEGAL ACTION TO RECOVER A DEBT

58
Q

MANUAL DAILY ACCOUNTS RECEIVABLE JOURNAL

A

CHRONOLOGICAL SUMMARY OF ALL TRANSACTIONS POSTED TO INDIVIDUAL PATIENT LEDGERS ON A SPECIFIC DAY

59
Q

METRICS

A

STANDARDS OF MEASUREMENT

60
Q

NONCOVVERED BENEFIT

A

ANY PROCEDURE OR SERVICE REPORTED ON A CLAIM THAT IS NOT INCLUDED ON THE PAYERS MASTER BENEFIT LIST

61
Q

NONPARTICIPATING PROVIDER NONPAR

A

DOSE NOT CONTRACT WITH THE INSURANCE PLAN PLATIENTS WHO ELECT TO RECIEVE CARE FORM NON PARS WILL HIGHER OUT OF POCKET EXPWNSES

62
Q

OPEN CLAIM

A

SUBMITTED TO THE PAYER BUT PROCESSING IS NOT COMPLETE

63
Q

OUT OF POCKET PAYMENT

A

ESTABLISHED BY HEALTH INSURANCE SOMPAINS FOR A HEALTH INSURANCE PLAN

64
Q

OUTSOURCE

A

CONTRACT OUT

65
Q

PARTICIPATING PROVIDER PAR

A

CONTACTS WITH A HEALTH INSURANE PLAN AND ACCEPTS WHATEVER THE PLAN PAYS FOR PROCEDURES OR SERVICES PERFORMEND

66
Q

PAST SURE ACCOUNT

A

ONE THAT HAS NOT BEEN PAID WITHIN A CERTAIN TIME FRAME

67
Q

PATIENT ACCOUNT RECORD

A

A COMPUTERIZED PERMANENT RECORD OF ALLL FINANICIAL TRANSACTIONS BETWEEN THE PATIENT AND THE PRACTICE

68
Q

PATIENT LEDGER

A

PATIENT ACCOUNG RECORD

69
Q

PREDADMISSION CERTIFICATION

A

REVIEW FOR MEDICAL NECCESSITY OF INPATIENT CARE PRIOR TO THE PATIENTS ADMISSION

70
Q

PREDADMISSION REVIEW

A

PREADMISSION CERTIFICATION

medicial billing and coding (8 decks)

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