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NHA
CBCS-STUDY TERMS FOR CERTIFIED BILLING AND CODING SPECIALIST
| Question | Answer |
|---|---|
| ACCOUNTS RECEIVABLE DEPARTMENT | MANAGES THE BILLING PROCESS FOR THE PROVIDERS- BILLING PROCESS, TRACKS PATIENTS SERVED BUT NOT PAID, MANAGES CHARGE DESCRIPTION MASTER |
| EXPLANATION OF BENEFITS (EOB) | DESCRIBES THE SERVICES RENDERED, PAYMENT COVERED AND BENEFIT LIMITS AND DENIALS |
| AGING REPORTS | ATB- AGE TRAIL BALANCE- STATUS OF INVOICE, WAIT FOR PAYMENTS |
| CHARGE DESCRIPTION MASTER (CDM) | DESCRIPTION OF SERVICE, CPT CODE/HCPCD CODE, REVENUE CODE, CHARGE AMT, SERVICE CODE, GENERAL LEDGER KEY, ACTIVITY, STATUS DATE |
| ACCOUNT NUMBER | NUMBER THAT IDENTIFIES SPECIFIC EPISODE OF CARE, DATE OF SERVICE, OR PATIENT |
| HEALTH RECORD NUMBER | NUMBER THE PROVIDER USES TO IDENTIFY AN INDIVIDUAL PATIENT'S RECORD |
| MEDICARE SUMMARY NOTICE (MSN) | |
| SUBSCRIBER | PURCHASER OF THE INSURANCE OF THE MEMBER OF GROUP FOR WHICH AN EMPLOYER OR ASSOCIATION 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 |
| NOTICE OF EXCLUSIONS FROM MEDICARE BENEFITS | NOTIFICATION BY THE PHYSICIAN TO A PATIENT THAT A SERVICE WILL NOT BE PAID |
| ADVANCE BENEFICIARY NOTICE OF NON COVERAGE | |
| RECONCILIATION | |
| WRITE OFF | THE DIFFERENCE BETWEEN THE PROVIDER'S ACTUAL CHARGE AND THE ALLOWABLE CHARGE |
| REVENUE CYCLE | |
| MEDICAL NECESSITY | THE DOCUMENTED NEED FOR A PARTICULAR MEDICAL INTERVENTION |
| REMITTANCE ADVICE (RA) | THE REPORT SENT FROM THE 3RD PARTY PAYER TO THE PROVIDER THAT REFLECTS ANY CHANGES MADE TO THE ORIGINAL BILLING |
| ADJUDICATION | |
| CLAIM CONTROL NUMBER | |
| NCCI EDITS | |
| PATIENT LEDGER ACCOUNT | |
| DENIAL | |
| BAD DEBT | |
| LIFE CYCLE OF A CLAIM | |
| PROSPECTIVE BILLING ACCOUNT AUDIT | |
| RECOVERY AUDIT CONTRACTOR (RAC) |
Created by:
LISA AJALA
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