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PoHR: Chapter 9

Principles of Healthcare Reimbursement: Chapter 9 Key Terms

AR accounts receivable- department in a healthcare facility that manages the amounts owed to the facility by customers who have received services but whose payment is made at a later date
CHARGE CAPTURE the process of collecting all services, procedures, and supplies provided during patient care
CDM charge description master- database used by healthcare facilities to house the price list for all services provided to patients
COPAYMENT cost-sharing measure in which the policy or certificate holder pays a fixed dollar amount (flat fee) per service, supply, or procedure that is owed to the healthcare facility by the patient. may vary by type of service
DEDUCTIBLE annual amount of money that the policyholder must incur (and pay) before the health insurance will assume liability for the remaining charges or covered expenses
EOB explanation of benefits- report sent from a healthcare insurer to the policyholder and to the provider that describes the healthcare service, its cost, applicable cost sharing, and the amount the healthcare insurer will cover
FI fiscal intermediary- local payment branch of the medicare program
HARD CODING use of the charge description master to code repetitive services
KPI key performance indicator- area identified for needed improvement through benchmarking and continuous quality improvement
MAC medicare administrative contractor- newly established contracting authority to administer medicare part a and part b
MEDICARE CARRIER contractor with medicare to process medicare part b claims; determines charges allowed by medicare and makes payment to physicians and suppliers on behalf of medicare
MSN medicare summary notice- statement that describes services rendered, payment covered, and benefits limits and denials for medicare beneficiaries
RA remittance advice- report sent by third-party payer that outlines claim rejections, denials, and payments to the facility; sent via electronic data interchange
RC revenue cycle- the regularly repeating set of events that produces revenue
RCM revenue cycle management- the supervision of all administrative and clinical functions that contribute to the capture, management, and collection of patient service revenue
Created by: jacquelinerose