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Kinn's Chapter 21
| Term | Definition |
|---|---|
| assignment of benefits | The transfer of the patient's legal right to collect benefits for medical expenses to the provider of those services: the patient authorizes sending of the payments directly to the provider. |
| audit | A process done before claims submission to examine claims for accuracy and completeness. An audit can be performed manually, or it can be done electronically with computer billing software. |
| audit trail | The path left by a transaction when it has been completed: often referred to when tracking medical services used by patients or researching claims. |
| clean claim | an insurance claim form that has been completed correctly (no errors or omissions); clean claims can be processed and paid promptly if they meet the restrictions on covered services and blocks. |
| clearinghouse | A centralized facility to which insurance claims are transmitted |
| direct billing | A method of electronic claims submission where computer software allows a provider to submit an insurance claim directly to an insurance carrier for payment. |
| dirty claim | A claim form that contains errors or omissions; dirty claims must be corrected and resubmitted to an insurance carrier to obtain reimbursement. |
| electronic claim | a claim submitted to an insurance processing facility through a computerized medium, such as direct data entry, direct wire, dial-in telephone digital fax, or personal computer download or upload. |
| electronic data interchange (EDI) | The transfer of data back and forth between two or more entities using an electronic medium. |
| electronic (or digital) signature | A scanned signature or other such mark that is accepted as proof of approval of and/or responsibility for the content of an electronic document |
| employer identification number (EIN) | The number used by the Internal Revenue Service that identifies a business or individual functioning as a business entity for income tax reporting. |
| intelligent character recognition (ICR) | The electronic scanning of printed blocks as images and the use of special software to recognize these images (or characters) as ASCII text for upload into a computer database |
| National Provider Identifier (NPI) | A lifetime number consisting of 10 digits that Medicare will use to replace the Provider Identification Number(PIN) and the Unique Physician Identification number (UPIN). |
| paper claim | a hard copy of an insurance claim; which is completed and sent by surface mail. |
| rejected claims | Claims returned unpaid to the provider for clarification of any question; rejected claims must be corrected before resubmission. |
| Unique Provider Identification Number (UPIN) | A number assigned by fiscal intermediaries to identify providers on claims for services. |
| universal claim form | The form used to submit all government sponsored claims; also know as the CMS-1500 form. It was developed by the agency that became the Centers for Medicare and Medicaid Services (CMS) and approved by the American Medical Association (AMA). |
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mrsdancona
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