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 |