Term
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Definition
| regular income, the cycle is a regular set of events that produce the income |
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Term
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Definition
| all administrative and clinical proceses that contribute to the capture, management, and collection of patient service revenue |
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Term
| the four components of RCM |
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Definition
| preclaims submission activities, claim processing activities, accounts recievable, and claims reconciliation |
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Term
| preclaims submission keywords (4) |
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Definition
| collect information, determine financial class, verify data, educate patient on fiscal responsibilities |
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Term
| claims processing activities definition |
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Definition
| capture of all billable services, claim generation, claim corrections |
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Term
| components of Charge Capture (Claims processing activities) |
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Definition
| order entry, charge description master, hard coding, CDM maintenance, soft coding, auditing and review, submission of claims |
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Term
| Submission of Claims legislation (Claims Processing Activities) |
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Definition
| HIPPA Final Rule of Standards and Transactions: Administrative simplification |
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Term
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Definition
| explains payments made by third party payers. aka reports claim rejections, denials, partial payments, and full payments |
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Term
| Accounts receivable components (3) |
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Definition
| insurance processing (even they use aduiting checks), benefits statements, remittance advice |
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Term
| fiscal intermediary (Accounts recievable:insurance processing) |
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Definition
| FIs contract with Medicare to process claims for a specific area or region |
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Term
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Definition
| part of the transaction rule, BOTH go to patients AND facilities (facilities through EDI) |
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Term
| Claims reconciliation and collection |
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Definition
| step 4 of RCM, does write offs, adjustments, and resubmissions |
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Term
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Definition
Three digit number used for Medicare and other TPP billing; APC depends on revenue codes;
Types:
Clinic 51x
ED 45x
Parmacy 25x and 63 x
Supplies 27x
OR 36x |
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Term
| Advance Beneficiary Notice (Preclaims submission activities: compliance issue) |
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Definition
| education portion, lets consumers know what will/will not likely be covered so they can make more informed decisions |
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