Intro to the revenue cycle Flashcards

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1
Q

cash flow

A
  • movement of monies into or out of a business
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2
Q

accounts receivable

A
  • monies owed to a medical practice
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3
Q

accounts payable

A
  • a practice’s operating expenses
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4
Q

revenue cycle

A
  • all administrative and clinical functions that help capture and collect patient’s payment for medical expenses
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5
Q

health information technology (HIT)

A

computer information systems that record, store, and manage patient information

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6
Q

practice management program (PMP)

A

accounting software used for scheduling appointments, billing, and financial record keeping

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7
Q

electronic health record (EHR)

A

computerized lifelong healthcare record for an individual that incorporates data from all sources

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8
Q

PM/EHR

A

software program that combines both a PMP and an EHR into a single product

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9
Q

medical insurance

A

a written policy stating the terms of an agreement between a policy holder and a health plan

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10
Q

policyholder

A

person who buys an insurance plan

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11
Q

health plan

A

individual or group plan that provides or pays for medical care

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12
Q

benefits

A

health plan payments for covered medical services

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13
Q

payer

A

health plan or program

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14
Q

third-party payer

A

private of government organization that insures or pays for healthcare on behalf of beneficiaries

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15
Q

schedule of benefits

A

list of medical expenses covered by a health plan

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16
Q

medical necessity

A

payment criterion that requires medical treatments to be appropriate and provided in accordance with generally accepted standards

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17
Q

provider

A

person or entity that supplies medical or health services and bills for, or is paid for, the services in the normal course of business

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18
Q

covered services

A

medical procedures and treatments that are included as benefits in a health plan

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19
Q

preventive medical services

A

care provided to keep patients healthy or prevent illness

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20
Q

noncovered services

A

medical procedures that are not included in a plan’s benefits

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21
Q

excluded services

A

services not covered in a medical insurance contract

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22
Q

indemnity plan

A

health plan that reimburses a policyholder for medical services under the terms of its schedule of benefits

23
Q

healthcare claim

A

electronic transaction or a paper document filed to receive benefits

24
Q

premium

A

money the insured pays to a health plan for a policy

25
Q

deductible

A

amount the insured must pay for healthcare services before a health plan’s payment begins

26
Q

coinsurance

A

portion of charges an insured person must pay for covered healthcare services after the deductible

27
Q

out-of-pocket

A

expenses the insured must pay prior to benefits

28
Q

fee-for-service

A

payment method based on provider charges

29
Q

managed care

A

system combining the financing and delivery of healthcare services

30
Q

managed care organization (MCO

A

organization offering a managed healthcare plan

31
Q

participation

A

contractual agreement to provide medical services to a payer’s policyholders

32
Q

health maintenance organization

A

managed healthcare system in which providers offer healthcare to members for fixed periodic payments

33
Q

capitation

A

a fixed prepayment covering provider’s services for a plan member for a specified period

34
Q

per member per month (PMPM)

A

periodic capitated prospective payment to a provider that covers only services listed on the schedule of benefits

35
Q

network

A

a group of healthcare providers including physicians and hospitals, who sign a contract with a health plan to provide services to plan members

36
Q

out-of-network

A

provider who does not have a participation agreement with a plan

37
Q

preauthorization

A

prior authorization from a payer for services to be provided

38
Q

copayment

A

specified amount a beneficiary must pay at the time of a healthcare encounter

39
Q

primary care physician (PCP)

A

physician in a health maintenance organization who directs all aspects of a patient’s care

40
Q

referral

A

transfer of patient care from one physician to another

41
Q

preferred provider organization (PPO)

A

managed care organization in which a network of providers supplies discounted treatment for plan members

42
Q

consumer driven health plan (CMHP)

A

medical insurance that combines a high deductible health plan with a medical savings plan

43
Q

self funded (self insured) health plan

A

organization pays for health insurance directly and sets up a fund from which to pay

44
Q

medical insurance specialist

A

staff member who handles billing, checks insurance, and processes payments

45
Q

medical coder

A

staff member with specialized training who handles diagnostic and procedural coding

46
Q

diagnosis code

A

number assigned to a diagnosis

47
Q

procedure code

A

code that identifies medical treatment or diagnostic services

48
Q

patient ledger

A

record of a patient’s financial transactions

49
Q

compliance

A

actions that satisfy official requirements

50
Q

adjudication

A

health plan process of examining claims and determining benefits

51
Q

professionalism

A

acting for the good of the public and the medical practice

52
Q

ethics

A

standards of conduct based on moral principles

53
Q

etiquette

A

standards of professional behavior

54
Q

certification

A

recognition of a superior level of skill by an official organization