Billing, Reimbursement & Collections/Essential Financial Records
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| Clearinghouse | A service bureau that collects electronic claims from many different medical practices and forwards the claims to the appropriate insurance carriers.
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| Clean Claim | A medical insurance claim that is free of erros that can be adjudicated.
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| CMS-1500 claim form | Universal claim form/paper claim form.
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| Collection agency | A business whose purpose is to collect unpaid debts, usually used once all efforts have been exhausted by the physician office.
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| Collection at the time of service | The payment for services by patients at the time of the visit or collection of co-payments at time of service.
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| Collection ratio | A percentage used to show the effectiveness of collection practices, the higher the collection ratio, the better the collection practices.
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| Cycle billing | A method of billing patients to stabilize cash flow and workload by dividing patients into groups.
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| Dependant | A person related to a policyholder, such as a spouse or child.
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| Electronic claims | Claims that are completed and transmitted to insurance companies by computer.
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| EOB | Explanation of Benefits-Report sent to the patient and healthcare provider by the insurance carrier informing them of the final reimbursement determination.
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| ERA | Electronic remittance advice-Payment determination report sent by insurance carrier.
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| Fee adjustment | The reduction of a fee based on the physician's decision of the patient's need.
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| Fee schedule | A listing of medical procedures and/or services and usual charges.
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| Guarantor | The insurance policyholder for a patient.
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| Monthly billing | The system of sending each patient and updated statement of payments made and charges owed to the physician once per month.
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| Patient information form | A form used to collect a patient's personal and insurance information, usually updated at least every 12 months.
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| Patient statement | An accounting of patient services, charges, payments/adjustments and balance that is sent to the patient.
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| Scrubber program | Software used to detect and correct medical insurance claims prior to being submitted to the insurance carrier.
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| Terminated account | The account of a patient from whom it has not been possible to extract payment or the status of accounts where the patient/physician relationship ended for other reasons.
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| Third-party liability | The assumption of responsibility for charges related to a patient by someone other than the patient.
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| Write-off | Financial adjustment for PAR providers of the difference between submitted and allowable charges.
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| Collections from patients are regulated by... | Federal and state law
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| Bookkeeping | The accurate recording of financial transactions
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| Cash basis | System of accounting whereby charges for services are not recorded as income to the practice until payment is received and expenses until they are paid
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| Accrual method | Accounting method whereby income is recorded as soon as it is earned and expenses are recorded whey they are incurred.
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| Posting | Activity of transferring an amount from one record to another
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| Daily journal | Record of services rendered by the physician, daily fees charged and payments received
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| Charge/receipt slips | Records of the doctor's services to each patient and the charges combined with a tear-off receipt for the patient.
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| Patient ledger cards | A financial record containing patients name, services rendered, charges, payment and balance.
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| Accounts payable | Unpaid amounts of money owed by the practice to creditors, vendors/suppliers
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| Accounts receivable | Unpaid amounts of money owed to the practice by patients and third party payers.
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| Monthly summary | Report that shows the daily charges and payments for the entire month
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| Annual summary | Report providing the monthly charges and payment for an entire year.
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| Balance sheet | Report for a stated period indicating the practice's complete assets, liabilities and capital.
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| Income statement | Financial statement showing profit and loss for a stated period of time.
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| Procedure day sheet | Numeric listing of all procedures performed on a given day and includes patient names, document numbers, place of service.
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| Practice analysis report | Report used to analyze the revenue of the practice during a specific period of time and contains lab charges, patient payments, copayments and adjustments.
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| Aging report | Report that shows the passage of time between request for payment and receipt of payment.
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