Lesson 4

Question 1

Revenue

Answer 1

As the total amount of money that a business receives from its normal operations over a period of time (such as a year)

Question 2

Accounts receivable management

Answer 2

Also known as revenue cycle management. (RCM) is therefore a key financial proces that is crucial for healthcare providers to receive payment from patients and third party payers for their services.

Question 3

Cash flow

Answer 3

Is the cash that a business has generated and has available for use. Especially to pay expenses.

Question 4

Accounts receivable

Answer 4

The amounts owed to a medical practice for services rendered.

Question 5

Claims submission

Answer 5

Is the transmission of claims data to payers for processing.

Question 6

Electronic data interchange (EDI)

Answer 6

Is the computer to computer transfer of data between providers and third part payers.

Question 7

Clearing house

Answer 7

Acts as the middleman in the claims submission process, making it easier for providers to submit claims to many different insurance carriers

Question 8

Clean claim

Answer 8

A clean claim has no errors and is paid upon submission.

Question 9

Claims adjuctication

Answer 9

Every Insurance claim undergoes a process to determine whether the insurance company should pay it or not. And this process is known as adjudication.

Question 10

Remittance advice

Answer 10

Is a document that the third party payer sends to the provider to explain how they determined the reimbursement for a claim.

Question 11

Allowable charge

Answer 11

This is the maximum amount that an Insurer will reimburse for a covered service or procedure. Allowable charges are less than or equal to the providers fee. They are never more.

Question 12

Guarantor

Answer 12

Is the person who ultimately accepts financial responsibility to pay the patients bill.

Question 13

Coordination of benefits (COB)

Answer 13

It applies when an individual is covered by more than one insurance policy. The important point to remember is that the payments made by all the insurance companies may not exceed 100% of the total bill.

Question 14

Birthday tule

Answer 14

Determined which health insurance coverage is the primary payer. Look at the birth month and day of both parents. Not the year. And whoever’s birthday comes earlier in the calendar year is the one who’s insurance is used as the primary payer.

Question 15

Price transparency

Answer 15

Letting patients know in advance what they are going to have to pay for healthcare services, including out of pocket costs.