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Mod H Unit 4
The Patient/The Claim
36
Health Care
Not Applicable
02/25/2013
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Term
accounts receivable
 Definition
The entire group of patient ledgers.
Term
alternate billing cycle
 Definition
A billing system that incorporates the mailing of a partial group of statements at spaced intervals during the month.
Term
assignment of benefits
 Definition
An arrangement where a patient requests that their health insurance payments be made directly to the clinic or physician.
Term
billing cycle
 Definition
The process of mailing statements periodically. Typically every 30 days.
Term
collection agency
 Definition
An organization that obtains or arranges for payment of money owed to a third party.
Term
collection ratio
 Definition
The total amount collected divided by the total amount charged.
Term
daily journal
 Definition
A chronological record of all patient transactions, including previous balances, charges, payments, and current balances for that day.
Term
defendant
 Definition
The party being sued.
Term
de-identified
 Definition
When all identifiable elements are removed.
Term
disbursement journal
 Definition
A listing of all expenses paid out to vendors.
Term
general journal
 Definition
A chronological listing of transactions.
Term
general ledger
 Definition
A permanent tracking of the history of all financial transactions of a clinic.
Term
identifiable health information
 Definition
Patient information that allows a patient to be indentified (ex: name, dob, ssn)
Term
patient ledger
 Definition
A chronological accounting of a particular patient's activities, including all charges and payments.
Term
payroll journal
 Definition
A journal for wages and salaries.
Term
plaintiff
 Definition
The party bringing the lawsuit.
Term
self-pay patient
 Definition
Patients with inadequate health insurance coverage or no coverage at all.
Term
small claims litigation
 Definition
An alternative to turning accounts over for collection.
Term
surrogates
 Definition
substitutes
Term
patient information form
 Definition
A form a patient fills out with the name, address, employer, and health insurance information.
Term
One-write systems (pegboard systems)
 Definition
A useful method of accounting for small practices where information is captured at the time the transaction occurs.
Term
Fair Debt Collection Practices Act
 Definition
Addresses abusive methods used by third-party collectors.
Term
adjudication
 Definition
The process of a third-pary payer reviewing a claim and making payment decisions.
Term
birthday rule
 Definition
The payer whose subscriber has the earlier birthday in the calendar year is generally primary.
Term
clean claim
 Definition
All the information necessary for processing a claim has been entered on the claim form and the information is correct.
Term
coordination of benefits
 Definition
When a patient has two separate group policies and the insurance professional must figure out which to bill first.
Term
correct code initiative
 Definition
The result of the NCCI, which develops correct coding methods.
Term
downcoding
 Definition
Occurs when claims are submitted with outdated, deleted, or nonexistent CPT codes.
Term
employer identification number (EIN)
 Definition
A nine digit number, assigned to employers by the IRS as their tax ID number.
Term
hearing on record
 Definition
A hearing officer investigates all aspects of the claim, but the physician does not testiful unless necessary. Usually the most productive hearing procedure.
Term
insurance claims register (log)
 Definition
A columnar form that is an alternative to the suspension file.
Term
Medicare Secondary Payer claims
 Definition
Claims that are submitted to another insurance company before they are submitted to Medicare.
Term
personal hearing
 Definition
When the provider believes a hearing is best done in person, the Medicare hearing officer may schedule a face-to-face meeting.
Term
secondary claim
 Definition
When a second carrier receives a claim after the primary carrier pays its monetary obligations.
Term
suspension file
 Definition
A series of files set up chronologically ad labeled according to the number of days since the claim was submitted.
Term
telephone hearing
 Definition
The provider presents the case to a hearing officer. Before the hearing the physician is provided w/information in the hearing officer's file. The provider is told of the decision & a copy is sent to Medicare.
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