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PoHR: Chapter 9
Principles of Healthcare Reimbursement: Chapter 9 Key Terms
| Term | Definition |
|---|---|
| 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
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