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Billing Term

Mop 130 Lynn Chambers

TermDefinition
Accounts receivable (A/R) Unpaid accounts and uncollected balances
accounts receivable aging report Report utilized for determining account age and working oldest accounts first and determining the number of days it takes the facility to collect accounts
adjudication Advisement of a patient by a third-party carrier regarding processing of the patient's claim
Advance Beneficiary Notice A form that Medicare patients are requested to sign fi services are believed not covered prior to provision
allowance The amount agreed upon by the carrier and the provider as payment in full
appeal A formal request 4 reconsideration when appropriate reimbursement has not been made or a request made 2 the insurance carrier 4 additional consideration and payment when payment does not appear to agree with the insurance carrier's contractual guidelines
appeals letter Letter sent to insurance carrier requesting additional consideration for reimbursement on a claim based on additional presenting information
assignment of benefits A document obtained during the admission/preadmission process indicating that the patient has "assigned" the right of payment directly to the facility, rather than monies for services being sent to the patient.
bundled Services that are considered included as a component of other services already billed
capitation plan A form of HMO in which the patient is covered under a per-member-per-month (PMPM) fee.
Centers for Medicare and Medicaid Services (CMS) The governmental agency that oversees the Medicare and Medicaid programs for the federal government.
CHAMPVA The Civilian Health and Medical Program of the Department of Veterans Affairs, a program to help retired military personnel pay medical costs.
charge capturing The gathering of charge documents from all departments within a facility that have provided services to patients, and the process by which a facility ensures that all services it performs have been coded and billed appropriately.
charge description master (CDM)/ charge master The part of a facility's computerized billing system that maintains all services, codes, and charges provided by the facility
charge ticket/encounter form A form on which facility personnel record patient information, services performed, and a diagnosis
clean claim A claim without errors or omissions that meets all predetermined specifications by the carrier
clearing house A third-party entity where claims are sent before being forwarded to the carrier for screening purposes to ensure all requirements for that carrier have been met
CMS-1450/ Uniform billing, 2004 (UB-04) claim form, sometimes referred to as HCFA 1450 or UB-04 by which compensation is considered for inpatient and outpatient facilities
Created by: lynn559