Payment Adjudication
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each of the black spaces below before clicking
on it to display the answer.
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| accounts receivable department | department that keeps track of what 3rd party payers provide on what patients are due
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| explanation of benefits (EOB) | describes the services rendered, payments covered benefits and denials
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| CPT/HCPCS codes | must correspond to the description of the service
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| aging report | measures the outstanding balances in each account
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| charge description master (CDM) | Information about health care services that patients have received and financial transactions
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| Age trial balance (ATB) | refers to the status of an invoice aging reports often maintained in 30-day increments
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| 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
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| account number | number that identifies specific episodes of care for date of service(DOS)
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| health record number | number the provider uses to identify an individual patient's record
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| Medicare summary notice(MSN) | document that outlines the amounts billed by the provider and what the patients pay the provider
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| Remittance Advice(RA) | the report sent from the third party payer to the provider
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| subscriber | purchaser of the insurance or the member of group for which an employer or associations as purchased insurance
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| subscriber number | unique code used to identify a subscriber's policy
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| cost sharing | the balance the policyholder must pay to the provider
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| batch | a group of submitted claims
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| balance billing | billing patients for charges in excess of the Medicare fee schedule
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| managing denials | important to track denials when payments are posted tracked by payer type of denials and provider
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| affordable care act | how patients can appeal health insurance decisions
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| External Independent | if claim is still denied internal appeal patient can request an external independent review
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Created by:
K.Lindsey
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