Revenue Cycle

Question 1

Free or discounted medical care provided to patients who do not have the ability to pay for all or part of medical costs due to a limited income or financial hardship

Answer 1

Charity care

Question 2

An accounts receivable that is regarded as uncollectible and is charged as a credit loss even though the patient has the ability to pay

Answer 2

Bad debt

Question 3

Requires employers permit employees or family members to continue their group health coverage at their own expense but at group rates if they lose coverage from loss of employment, divorce, death of supporting spouse, or other designated events

Answer 3

COBRA

consumer omnibus budget reconciliation act

Question 4

Percentage of total allowable amount; method of cost sharing in which the subscriber is responsible for a specified percentage of the cost of healthcare are under fee for service plans

Answer 4

Co-insurance

Question 5

An outside vendor that collects payment on hospital accounts under contract with the hospital when the hospital is unable to collect amount themselves

Answer 5

Collection agency

Question 6

The determination of primary,secondary, tertiary payers , must be completed at either the registration process or through the verification process

Answer 6

COB

coordination of benefits

Question 7

A fixed amount that a beneficiary Pays for healthcare services, regardless of the actual charge

Answer 7

Copay

Question 8

Comprehensive list of descriptive terms and identifying codes for reporting medical services and procedures performed by physicians; level one of HCPCS

Answer 8

CPT codes

Current procedural terminology codes

Question 9

Cost sharing arrangement where a beneficiary must contribute a fixed amount towards the cost of their healthcare before insurance benefits begin

Answer 9

Deductible

Question 10

When a person is entitled to benefits according to an employer or union and is currently covered by insurance

Answer 10

Eligibility

Question 11

Specific services not covered under a benefits plan

Answer 11

Exclusions

Question 12

Evaluating the financial situations of medical facility patients and identifying or arranging a method of payment or alternatives for services rendered

Answer 12

Financial counseling

Question 13

Physician or healthcare delivery systems that are not contacted to provide services covered by a specific health plan

Answer 13

Out of network

Question 14

Dollars amounts that limit the amount a member has to pay out of their pocket for particular healthcare services during a particular time period

Answer 14

Out of pocket maximums

Question 15

Approval obtained from an insurance carried for a service that represents an agreement for payment

Answer 15

authorization

Question 16

Mandated by CMS; federal directive requiring a hospital follow specific billing procedures itemizing all services included and billed for on each invoice

Answer 16

UB 04

Uniform bill 04

Question 17

To attest to meeting a standard of care prior to a service; specific criteria must be met by the patient for the service to be performed; May be required from primary care physician prior to services being performed

Answer 17

Pre certification

Question 18

Applied to determine whose insurance is primary for a minor child covered under both parents insurance. The parent whose birthday falls earlier in the year (1/1) becomes the primary insurance and the other becomes secondary

Answer 18

Birthday rule

Question 19

A form used in managed care plans for the Primary Care Physicians authorization for certain specialists or services

Answer 19

Referral

Question 20

Organization of medical doctors, hospitals, and other healthcare providers who have covenants with an insurer or third party administrator to provide healthcare at reduced rates to the insurers or administrators clients

Answer 20

MCO

Managed Care Organization

Question 21

The service the third party payer will pay based in the coverage plan

Answer 21

Benefit level

Question 22

Describe diagnoses, symptoms, conditions, or complains for billing purposes

Answer 22

ICD codes

Question 23

Health insurance provided through an employer

Answer 23

EGHP

employer group health plan

Question 24

Statements that explain how a claim was handled; details services provided, benefits paid on them, deductible or copayment amounts, and any remaining balance due

Answer 24

EOB

Explanations of benefits

Question 25

System of letter and number codes assigned to services and supplies used for pricing and billing; maintained by CMS; used in HIPAA transactions; CPT codes represent level one of

Answer 25

HCPCS

healthcare common procedure coding system

Question 26

Nationwide and Federally administered health insurance program authorized to cover hospitalization, medical care, and related services for elderly, disabled persons receiving social security benefits, and persons with end stage renal disease

Answer 26

Medicare

Question 27

A kidney impairment that appears irreversible and permanent and requires a regular course of dialysis or kidney transplant to maintain life

Answer 27

ESRD

End Stage Renal Disease

Question 28

Period when Medicare is secondary payer to another type of insurance when a patient has ESRD, Medicare, and another type of insurance

Answer 28

30 month coordination period