Rev Cycle
This process of the revenue cycle includes claims processing, payment posting, follow-up, collections, and denials management.
What is "back-end process"?
This is an amount owed, often due to acquiring an asset.
What is a "liability"?
This is an extensive annual report required of facilities that provide services to Medicare patients. This report provides valuable benchmarking data for providers and payers.
What is a "cost report"?
__________ is when the insurance company and the healthcare provider come into an agreement so that when they healthcare provider delivers service to patients, the insurance company will provide reimbursement.
What is "provider contracting"?
This form is used when a healthcare provider is furnishing an item or providing a service that is usually paid form by Medicare but might not be covered in this specific instance.
What is "Advanced Beneficiary Notice" (ABN)?
Patients whose encounters have ended but for whom a final bill has not been prepared- the report that lists these encounters is called _______.
What is discharged, no final bill (DNFB) or unbilled report?
Also known as a statement of operations, this statement summarizes the organizations revenue and expenses during a fiscal year.
What is an "income statement"?
This ratio is developed by taking the total allocated costs for a service, a department, or the entire organization and dividing it by the total charges for the same.
What is "cost-to-charge ratio"?
This type of reimbursement system is based on preset payment levels rather than actual charges billed after the service has been provided.
What is "prospective payment system"?
This is a federal health insurance plan for individuals who are 65 or older, individuals with disabilities, and those with end-stage renal disease (ESRD).
What is "Medicare"?
This type of governance is concerned with who has access to data and how data is used.
What is "information governance"?
These two basic financial strategies are used in hospitals to increase their bottom line __________ and _____________.
What is "increase revenue" and "decrease costs"?
This number is derived from the resources used to provide a particular service- can be used both to identify the cost of the service as well as the charge.
What is "relative value unit" (RVU)?
This reimbursement type pays a healthcare provider a set dollar amount each month for each patient.
What is "capitation"?
These types of codes are five-digit numeric or alphanumeric codes used to report procedures, treatments, and diagnostic and therapeutic services that were performed in the outpatient setting. (Ex. 24500)
What is "Current Procedural Terminology" (CPT)?
This is any activity that verifies the compliance of a process or the output of a process with predetermined standards.
What is "quality assurance"?
A healthcare facility's electric bill, salaries to employees, and copy machine rental would be listed as a(n) ________ on the income statement.
What is an "expense"?
Depreciation, housekeeping, utilities, employee benefits, and maintenance are all examples of __________ costs.
What is "indirect"?
That which is done erroneously to purposely achieve gain from another.
What is "fraud"?
__________ refers to the reason why a healthcare service or treatment is performed.
What is "medical necessity"?
This quality methodology asks "why" in every situation until you discover the root cause of an issue. It typically targets inefficiencies in a process in an effort to streamline the process.
What is "lean methodology"?
Failure to claim and collect ________ on a timely basis means that cash comes in slowly and the facility may not be able to keep up with payments on its current liabilities, the largest of which is payroll.
What is "accounts receivable" (A/R)?
This term refers to all the underlying resources expended to achieve a specific objective.
What is "cost"?
This prospective payment system is utilized in long-term acute care facilities.
What is "Medicare severity-adjusted long-term acute care diagnosis related groups" (MS-LTC-DRG)?
This refers to linking diagnosis and procedure codes together to identify the medical necessity for specific procedures.
What is "code linking"?