Revenue Cycle
Terms Mean Things
Where Do I Find?
System Overload
Collections
100
This department submits the claim to the insurance company.
Billing
100
These are known as:
Insurance cards
100
Daily Assignments
Job Board
100
System used to verify if a claim has been billed.
SSI
100
Before some services are covered, approval for services, which is based on medical necessity is required by the health plan.
Prior authorization
200
This department verifies the patient's information and insurance.
Registration/ PAU
200
Family members of the policy holder, such as spouse, children or partner.
Dependents
200
Weekly Productivity Averages
WFO
200
Web-based collections management and reporting platform, used to work accounts.
Artiva Webstation/Workstation
200
Medical services, procedures or supplies not included in a patient's insurance policy.
Non-covered charges
300
This department translates the medical records into billable codes.
Coding
300
The person held financially accountable for the patient’s bill.
The Guarantor
300
Team Specific Folders, Reference Materials, MDI Huddle Notes, etc.
Team Shared Drive
8175 SSC Nashville Managed Medicare
300
Database used for the long-term storage of patient records and insurance cards.
Cerner-Powerchart/ CPDI-App Bar/ MPF
300
IP SA and IP PD payer plan.
Downgrades
400
This department sets the initial appointment for service.
Scheduling/ PAU
400
A bill submitted to the insurance company by a healthcare provider for medical services rendered.
Claim/ UB-04
400
Reimbursement Rates
Finthrive - Contract Management
400
Application used to view electronic and paper documents such as EOBS, Remits, Refund Letters.
DocPop
400
Can occur when there is an overpayment on an account.
Credit Balance/ Recoup/ Refund
500
This department identifies and resolve barriers for account resolution.
Accounts Receivable
500
An electronic version of the explanation of benefits (EOB), providing details about the insurance payment or claim denial.
Remittance advice (Remit)
500
W9 Forms
File Explorer Folder - Shared\RCSC
500
Web-based application that must be used when submitting "final" denials
Denial Note Creator
500
A private alternative to Original Medicare that manages costs and care through networks, such as HMOs or PPOs.
Managed Medicare / Medicare Advantage