chapter 4 revenue cycle management

Question 1

ACCEPT ASSIGNMENT

Answer 1

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

Question 2

ACCOOUNTS RECEIVABLE

Answer 2

THE AMOUNT OWED TO A BUSINESS FOR SERVICES OR GOODS PROVIDED

Question 3

ACCOUNT RECEIVABLE AGING REPORT

Answer 3

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

Question 4

ACCOUNTS RECEIVABLE MANAGEMENT

Answer 4

ASSUSTS PROVIDERS IN THE COLLECTION OMF APPROPRIATE REIMBURSEMENT FOR SERVIES RENDERED

Question 5

ALLOWED CHARGES

Answer 5

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

Question 6

APPEAL

Answer 6

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

Question 6

ANSI ASC X12N

Answer 6

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

Question 7

BAD DEBT

Answer 7

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

Question 7

ASSIGNMENT OF BENEFITS

Answer 7

THE ORIVIDER RECIVES REIMBURSSEMENT DIRECTLY FROM TEH PAYER

Question 8

BENEFICIARY

Answer 8

PERSON ELIGIBLE TO RECEIVE HEALTH CARE BENEFITS

Question 9

BIRTHDAY RULE

Answer 9

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

Question 10

CASE MANAGEMENT

Answer 10

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

Question 11

CHARE DESCRIPTION MASTER CDM

Answer 11

CHARGEMASTER

Question 12

CHARGEMASTER

Answer 12

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

Question 13

CHARGEMASTER MAINTENANCE

Answer 13

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

Question 14

CHARGEMASTER TEAM

Answer 14

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

Question 15

CLAIMS ADJUDICATION

Answer 15

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

Question 16

CLAIMS ADJUSTMENT REASON CODE CARC

Answer 16

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

Question 17

CLAIMS ATTACHMENT

Answer 17

MEDICAL REPORT SUBSTANTIATING A MEDICAL CONDITION

Question 18

CLAIMS DENIAL

Answer 18

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

Question 19

CLAIMS PROCESSING

Answer 19

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

Question 20

CLAIMS REJECTION

Answer 20

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

Question 21

CLAIMS SUBMISSION

Answer 21

THE TRANSMISSON OF CLAIMS DATA TO PAYERS OR CLEARINGHOUSES FOR PROCCESSING

Question 22

CLEAN CLAIM

Answer 22

CORRECTLY COMOLETED STANDARDIZED CLAIM

Question 23

CLEARINGHOUSE

Answer 23

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

Question 24

CLOSED CLAIM

Answer 24

CLAIMS FOR WHICH ALL PROCESSING INCLUDING APPEALS HAS BEEN COMPLETED

Question 25

COINSURANCE

Answer 25

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

Question 26

COMMON DATA FILE

Answer 26

ABSTRACT OF ALL RECENT CLAIMS FILED ON EACH PATIENT

Question 27

CONCURRENT REVIEW

Answer 27

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

Question 28

CONSUMER CREDIT PROTECTION ACT OF 1968`

Answer 28

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

Question 29

COORDINATION OF BENEFITS COB

Answer 29

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

Question 30

COVERED ENTITY

Answer 30

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

Question 31

DATA ANALYTICS

Answer 31

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

Question 32

DATA MINING

Answer 32

EXTRACTING AND ANALYZING DATA TO IDENTIFY PATTERNS

Question 33

DATA WAREHOUSE

Answer 33

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

Question 34

DAY SHEET

Answer 34

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

Question 35

DEDUCTIBLE

Answer 35

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

Question 36

DELINQUENT ACCOUNT

Answer 36

PAST DUE ACCOUNT

Question 37

DELINQUENT CLAIM

Answer 37

CLAIM USUALLY MARE THAN 120 DAYS PAST DUE

Question 38

DELINQUENT CLAIM CYCLE

Answer 38

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

Question 39

DENINED CLAIM

Answer 39

CLAIM RETURNED TO THE PROVIDER BY PAYERS DUE TO CODING ERRORS

Question 40

DISCHARGE PLANNING

Answer 40

INCOLVES ARRANGING APPROPRIATE HEALHT CARE SERVICES FOR THE DISCHARGED PATIENT

Question 41

DOWNCODING

Answer 41

ASSIGNING LOWER LEVEL CODES THAN DOCUMENTED IN THE RECORD

Question 42

ELECTRONIC DATA INTERCHANGE EDI

Answer 42

COMPUTER TO COMPUTER EXCHANGE OF DATA BETWEEN PROVIDER AND PAYER

Question 43

ELECTRONIC FLAT FILE FORMAT

Answer 43

SERIES OF FIXE DLENGTH RECORDS

Question 44

ELECTRONIC FUNDS TRANSFER EFT

Answer 44

SYSTEM BY WHICH PAYERS DEPOSIT FUNDS TO THE PROVIDERS ACCOUNT ELECTRONICALLY

Question 45

ELECTRONIC FUNDS TRANSFER ACT

Answer 45

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

Question 46

ELECTRONIC HEALTHCARE NETWORK ACCREDITATION COMMISSON EHNAC

Answer 46

ORGANIZATION THAT ACCREDITS CLEARINGHOUSES

Question 47

ELECTRONIC MEDIA CLAIM

Answer 47

ELECTRONIC FLAT FILE FORMAT

Question 48

ELECTRONIC REMITTANCE ADVICE ERA

Answer 48

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

Question 49

ENCOUNTER FORM

Answer 49

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

Question 50

EQUAL CREDIT OPPORTUNITY ACT

Answer 50

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

Question 51

FAIR CREDIT AND CHAREGE CARD DISCLOSURE ACT

Answer 51

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

Question 52

FAOR CREDIT BILLING ACT

Answer 52

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

Question 53

FAIR CREDIT REPORTING ACT

Answer 53

PROTECTS INFORMATION COLLEFCTED BY CONSUMER REPORTING AGENCIE SSUCH AS CREDIT DUREAUS

Question 54

FAIR DEBT COLLECTION P0RACTICES ACT FDCPA

Answer 54

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

Question 55

GUARANTOR

Answer 55

PEROSON RESPONSIBLE FOR PAYING HEALTH CARE FEES

Question 56

INTEGRATED REVENUE CYCLE IRC

Answer 56

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

Question 57

LITITGATION

Answer 57

LEGAL ACTION TO RECOVER A DEBT

Question 58

MANUAL DAILY ACCOUNTS RECEIVABLE JOURNAL

Answer 58

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

Question 59

METRICS

Answer 59

STANDARDS OF MEASUREMENT

Question 60

NONCOVVERED BENEFIT

Answer 60

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

Question 61

NONPARTICIPATING PROVIDER NONPAR

Answer 61

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

Question 62

OPEN CLAIM

Answer 62

SUBMITTED TO THE PAYER BUT PROCESSING IS NOT COMPLETE

Question 63

OUT OF POCKET PAYMENT

Answer 63

ESTABLISHED BY HEALTH INSURANCE SOMPAINS FOR A HEALTH INSURANCE PLAN

Question 64

OUTSOURCE

Answer 64

CONTRACT OUT

Question 65

PARTICIPATING PROVIDER PAR

Answer 65

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

Question 66

PAST SURE ACCOUNT

Answer 66

ONE THAT HAS NOT BEEN PAID WITHIN A CERTAIN TIME FRAME

Question 67

PATIENT ACCOUNT RECORD

Answer 67

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

Question 68

PATIENT LEDGER

Answer 68

PATIENT ACCOUNG RECORD

Question 69

PREDADMISSION CERTIFICATION

Answer 69

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

Question 70

PREDADMISSION REVIEW

Answer 70

PREADMISSION CERTIFICATION