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Billing Term
Mop 130 Lynn Chambers
| Term | Definition |
|---|---|
| Accounts receivable (A/R) | Unpaid accounts and uncollected balances |
| accounts receivable aging report | Report utilized for determining account age and working oldest accounts first and determining the number of days it takes the facility to collect accounts |
| adjudication | Advisement of a patient by a third-party carrier regarding processing of the patient's claim |
| Advance Beneficiary Notice | A form that Medicare patients are requested to sign fi services are believed not covered prior to provision |
| allowance | The amount agreed upon by the carrier and the provider as payment in full |
| appeal | A formal request 4 reconsideration when appropriate reimbursement has not been made or a request made 2 the insurance carrier 4 additional consideration and payment when payment does not appear to agree with the insurance carrier's contractual guidelines |
| appeals letter | Letter sent to insurance carrier requesting additional consideration for reimbursement on a claim based on additional presenting information |
| assignment of benefits | A document obtained during the admission/preadmission process indicating that the patient has "assigned" the right of payment directly to the facility, rather than monies for services being sent to the patient. |
| bundled | Services that are considered included as a component of other services already billed |
| capitation plan | A form of HMO in which the patient is covered under a per-member-per-month (PMPM) fee. |
| Centers for Medicare and Medicaid Services (CMS) | The governmental agency that oversees the Medicare and Medicaid programs for the federal government. |
| CHAMPVA | The Civilian Health and Medical Program of the Department of Veterans Affairs, a program to help retired military personnel pay medical costs. |
| charge capturing | The gathering of charge documents from all departments within a facility that have provided services to patients, and the process by which a facility ensures that all services it performs have been coded and billed appropriately. |
| charge description master (CDM)/ charge master | The part of a facility's computerized billing system that maintains all services, codes, and charges provided by the facility |
| charge ticket/encounter form | A form on which facility personnel record patient information, services performed, and a diagnosis |
| clean claim | A claim without errors or omissions that meets all predetermined specifications by the carrier |
| clearing house | A third-party entity where claims are sent before being forwarded to the carrier for screening purposes to ensure all requirements for that carrier have been met |
| CMS-1450/ | Uniform billing, 2004 (UB-04) claim form, sometimes referred to as HCFA 1450 or UB-04 by which compensation is considered for inpatient and outpatient facilities |
Created by:
lynn559
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