Revenue Cycle
The outstanding cash the facility will receive for the services it has provided
Accounts receivable
A 5 digit numerical code that describes a procedure
What is a CPT code?
Format that shows you how insurance paid a claim
What is a Remittance Advice (RA)
The process that allows you to make sure charges are correct
What is charge reconciliation?
The person who can explain your Financial Assistance policy to the patient
Who is the Financial Counselor?
The report that has all accounts as they age
ATB - Aged Trial Balance
An addition to a code that may modify the meaning of that code
What is a modifier?
Information sent to the patient that tells them how they paid a claim.
Explanation of Benefits (EOB)
New codes are updated here annually
What is the chargemaster?
The difference between what is charged and what is paid
What is the contractual allowance?
The tool used to catch claim errors
What is the bill scrubber?
The type of coding process that puts a code on the account from charging.
What is Hard coding?
The process that begins at first contact and continues until zero balance
What is the Revenue Cycle (RC)
The hospital price for the item or service rendered to the patient
The term "soft coding" refers to this process
What are CPT codes that are coded by the coder?
The area demographic and insurance information collected
Patient Access or Registration
The body responsible for processing Medicare claims
What is the Medicare Administrative Contractor (MAC)?
Internal claim auditing system used to ensure that claims are complete and accurate before submission to third-party payers.
Claim Scrubber
Charge type that are usually bundled into procedure payments
What are supplies?
This can increase the severity index of a DRG
What is a Complication/comorbidity?
The database that houses the price list and required claim data elements for all services.
Charge Description Master (CDM)
This will stop a claim from processing
What are Claims edits?
The date the federal fiscal year begins
What is October 1?
A charge entered after the chart has been final coded
What is a late charge?
Which of the following CDM data element is nationally recognized?
Revenue code