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Mod 4 MOP Ch 7 & 8.1
Billing, Reimbursement & Collections/Essential Financial Records
| Question | Answer |
|---|---|
| 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
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