Ch. 11-Revenue Cycle Back-End Processes--Claims Production And Revenue Collection

Question 1

Accounts receivable (AR)

Answer 1

The amounts owed to a facility by patients or insurance companies who receive services but whose parents will be made at a later date

Question 2

Accrual accounting

Answer 2

Method of accounting where an accounts receivable amount is recorded when services are provided to a patient

Question 3

Adjudication

Answer 3

The determination of the reimbursement amount based on the beneficiary’s insurance plan benefits

Question 4

Cash accounting

Answer 4

Method of accounting where all amounts are recorded when the cash or funds are exchanged

Question 5

Contractual allowance

Answer 5

The difference between the actual charge and allowable charge

Question 6

Days in accounts receivable

Answer 6

The result of dividing the ending accounts receivable balance for a given period by the average revenue per day

Question 7

Explanation of benefits (EOB)

Answer 7

Report sent from a healthcare insider to the policyholder that describes the healthcare service, it’s cost, applicable cost sharing, and the amount the healthcare insurer will cover

Question 8

Medicare administrative contractor (MAC)

Answer 8

Contracting authority to administer Medicare Part A and Part B as required by section 911 of the Medicare Modernization Act of 2003
They process and manage Part A and Part B claims

Question 9

Medicare summary notice (MSN)

Answer 9

Statement that describes services rendered, payment covered, and benefits limits and denials for Medicare beneficiaries

Question 10

Remittance advice (RA)

Answer 10

Report sent by third party payer that outlines claim rejections, denials, and payments to the facility; sent via electronic data interchange

Question 11

Scrubbers

Answer 11

Internal claim auditing system used to ensure that claims are complete and accurate before submission to third-party payers