Terminology Flashcards
Revenue Cycle includes…
The administration and clinical functions contributing to capturing a charge and receiving payment for services.
Aging Reports
Outstanding balances in each account
Outstanding balances in each report
Aging Report
Ancillary Services
Any service that supports the patient’s care, such as lab services
Any service that supports the patient’s care, such as lab services
Ancillary Services
Assignment
A legal agreement allowing the provider to receive payment from an insurance payer
A legal agreement allowing the provider to receive payment from an insurance payer
Assignment
Attending Physician
The doctor legally responsible for overseeing inpatient care
The doctor legally responsible for overseeing inpatient care
Attending Physician
Beneficiary/Subscriber/Dependent/Enrollee/Member/Participant
The person benefiting from the insurance coverage
The person benefiting from insurance coverage (6)
Beneficiary/Subscriber/Dependent/Enrollee/Member/Participant
Capitation
The fixed amount a provider receives
The fixed amount the provider receives
Capitation
Clean Claim
A claim submitted to a payer within the timely filing period that has current and accurate information
A claim submitted to a payer within the timely filing period that has current and accurate information
Clean Claim
Coinsurance
The percentage of a covered medical service the insured individual is responsible for paying
The percentage of a covered medical service the insured individual is responsible for paying
Coinsurance
Co-Payment
A fixed dollar amount the insured individual pays the day services are rendered
A fixed dollar amount the insured individual pays the day services are rendered
Co-Payment
Concurrent Care
More than 1 physician providing patient care at the same time
More than 1 physician providing patient care at the same time
Concurrent Care
Crossover Claim
A claim submitted from the primary payer to the secondary payer
A claim submitted from the primary payer to the secondary payer
Crossover Claim
Deductible
The dollar amount paid by the insured before medical claims are reimbursed to the provider
A dollar amount paid by the insured before medical claims are reimbursed to the provider
Deductible
Denial
A statement from an insurance payer that payment won’t be received
A statement from an insurance payer that payment won’t be received
Denial
Denial Codes
Detailed information explaining a rejection or denial, varies per payer
Detailed information explaining a rejection or denial, varies per payer
Denial Codes
Documentation
Detailed written facts of observations, diagnoses, services, and procedures related to the patient’s health
Detailed written facts of observations, diagnoses, services, and procedures related to the patient’s health
Documentation
DME
Durable Medical Equipment
