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Mod 4 MOP Ch 7 & 8.1

Billing, Reimbursement & Collections/Essential Financial Records

QuestionAnswer
Clearinghouse A service bureau that collects electronic claims from many different medical practices and forwards the claims to the appropriate insurance carriers.
Clean Claim A medical insurance claim that is free of erros that can be adjudicated.
CMS-1500 claim form Universal claim form/paper claim form.
Collection agency A business whose purpose is to collect unpaid debts, usually used once all efforts have been exhausted by the physician office.
Collection at the time of service The payment for services by patients at the time of the visit or collection of co-payments at time of service.
Collection ratio A percentage used to show the effectiveness of collection practices, the higher the collection ratio, the better the collection practices.
Cycle billing A method of billing patients to stabilize cash flow and workload by dividing patients into groups.
Dependant A person related to a policyholder, such as a spouse or child.
Electronic claims Claims that are completed and transmitted to insurance companies by computer.
EOB Explanation of Benefits-Report sent to the patient and healthcare provider by the insurance carrier informing them of the final reimbursement determination.
ERA Electronic remittance advice-Payment determination report sent by insurance carrier.
Fee adjustment The reduction of a fee based on the physician's decision of the patient's need.
Fee schedule A listing of medical procedures and/or services and usual charges.
Guarantor The insurance policyholder for a patient.
Monthly billing The system of sending each patient and updated statement of payments made and charges owed to the physician once per month.
Patient information form A form used to collect a patient's personal and insurance information, usually updated at least every 12 months.
Patient statement An accounting of patient services, charges, payments/adjustments and balance that is sent to the patient.
Scrubber program Software used to detect and correct medical insurance claims prior to being submitted to the insurance carrier.
Terminated account The account of a patient from whom it has not been possible to extract payment or the status of accounts where the patient/physician relationship ended for other reasons.
Third-party liability The assumption of responsibility for charges related to a patient by someone other than the patient.
Write-off Financial adjustment for PAR providers of the difference between submitted and allowable charges.
Collections from patients are regulated by... Federal and state law
Bookkeeping The accurate recording of financial transactions
Cash basis System of accounting whereby charges for services are not recorded as income to the practice until payment is received and expenses until they are paid
Accrual method Accounting method whereby income is recorded as soon as it is earned and expenses are recorded whey they are incurred.
Posting Activity of transferring an amount from one record to another
Daily journal Record of services rendered by the physician, daily fees charged and payments received
Charge/receipt slips Records of the doctor's services to each patient and the charges combined with a tear-off receipt for the patient.
Patient ledger cards A financial record containing patients name, services rendered, charges, payment and balance.
Accounts payable Unpaid amounts of money owed by the practice to creditors, vendors/suppliers
Accounts receivable Unpaid amounts of money owed to the practice by patients and third party payers.
Monthly summary Report that shows the daily charges and payments for the entire month
Annual summary Report providing the monthly charges and payment for an entire year.
Balance sheet Report for a stated period indicating the practice's complete assets, liabilities and capital.
Income statement Financial statement showing profit and loss for a stated period of time.
Procedure day sheet Numeric listing of all procedures performed on a given day and includes patient names, document numbers, place of service.
Practice analysis report Report used to analyze the revenue of the practice during a specific period of time and contains lab charges, patient payments, copayments and adjustments.
Aging report Report that shows the passage of time between request for payment and receipt of payment.
Created by: ROSSMIBOA