Help
Options
Didn't know it?
click below
click below
Knew it?
click below
click below
Don't Know
Remaining cards (0)
Know
retry
shuffle
restart
0:00
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
Chapter 4
Payment Adjudication
| Term | Definition |
|---|---|
| accounts receivable department | department that keeps track of what 3rd party payers provide on what patients are due |
| explanation of benefits (EOB) | describes the services rendered, payments covered benefits and denials |
| CPT/HCPCS codes | must correspond to the description of the service |
| aging report | measures the outstanding balances in each account |
| charge description master (CDM) | Information about health care services that patients have received and financial transactions |
| Age trial balance (ATB) | refers to the status of an invoice aging reports often maintained in 30-day increments |
| Assessing the Status Accounts | aging reports help the staff see which accounts have not been paid by checking the EOB or RA to tell why patient has an outstanding balance |
| account number | number that identifies specific episodes of care for date of service(DOS) |
| health record number | number the provider uses to identify an individual patient's record |
| Medicare summary notice(MSN) | document that outlines the amounts billed by the provider and what the patients pay the provider |
| Remittance Advice(RA) | the report sent from the third party payer to the provider |
| subscriber | purchaser of the insurance or the member of group for which an employer or associations as purchased insurance |
| subscriber number | unique code used to identify a subscriber's policy |
| cost sharing | the balance the policyholder must pay to the provider |
| batch | a group of submitted claims |
| balance billing | billing patients for charges in excess of the Medicare fee schedule |
| managing denials | important to track denials when payments are posted tracked by payer type of denials and provider |
| affordable care act | how patients can appeal health insurance decisions |
| External Independent | if claim is still denied internal appeal patient can request an external independent review |
Created by:
K.Lindsey
Popular Medical sets