Hospital Terms
HealthTech
Insurance
Admissions
Hospital Billing
Revenue Cycle
File Types
RCM Orgs
Coding Terms
100

This acronym describes "Short-term acute care"

What is "STAC"?

100

This is a system that contains a digital version of a patient’s paper chart.

Examples: Meditech, Epic, Cerner, CPSI, etc.


What is an "EHR or EMR"?

100

The United States federal government health insurance program for Americans who are 65 years of age or older

What is "Medicare"?

100

This acronym refers to point-of-service

What is "POS"?

100

Charges accumulating on a patient’s claim who is still receiving inpatient services and hasn’t been discharged

What are "In-House" charges?

100

A metric for measuring claims which have no defects or special circumstances and have a timely payment as a subset of all claims

What is the "Clean Claim or Validation Rate" (CCR)?

100

A file with claims sent to a payer, Institutional, services in a facility

What is the "837I" file?

100

HFMA

What is the acronym for the "Healthcare Financial Management Association"?

100

The 10th revision of the International Statistical Classification of Diseases and Related Health Problems, a medical classification list by the World Health Organization

What is the ICD10?

200

This acronym describes "Long-term acute care"

What is "LTAC"?

200

This is a shared instance of a larger EMR (Epic, Cerner, etc.) that certain hospital systems can provide to smaller regional facilities. Often available at a lower cost but limited in customization options.

What is a "Community Connect"?

200

Supplemental health insurance for Medicare

What is "Medigap"?

200

This acronym refers to a treatment authorization request

What is a "TAR"?

200

When hospitals will hold a bill for a period of 3-7 days to allow departments to get their charges in

What are "Bill Hold Days"?

200

A calculation that compares the total dollar amount of claims that have been rejected by payers within a given time period to the total dollar amount of claims submitted within the same time period

What is the "Denial Rate"?

200

A file with claims sent to a payer, Professional, a professional's time

What is the "837P" file?

200

AAHAM

What is the acronym for the "American Association of Healthcare Administrative Management"?

200

A listing of every item, service or procedure that a hospital could provide

What is the "Chargemaster" (CDM)?

300

This is a designation given to eligible rural hospitals by CMS and was put in place to reduce the financial vulnerability of rural hospitals

•    25 or fewer acute care inpatient beds

•    Located more than 35 miles from another hospital

What is a "Critical Access Hospital" (CAH)?

300

This is a subsystem of a hospital information system used for storing financial data, calculating healthcare costs, and providing billing information.

What is a "Patient Accounting System" (PAS)?

300

These are costs that are a patient's responsibility for hospitalization between day 61-90 days

What are "Medicare Coinsurance Days"?

300

A responsible party and/or insured party who is not necessarily the patient.

Who is a "Guarantor"?

300

Hospital bills that have completed service but have not been billed to insurance yet

What is "Discharged, Not Final Billed" (DNFB)?

300

Outstanding charges that are the patient's responsibility that have not been successfully collected which are eventually written off and sent to a collection agency

What is "Bad Debt"?

300

An transaction set and electronic version of an Application Advice document, used to notify the sender of a previous transaction that the document has been accepted, or to report on errors

What is the "824" file?

300

MGMA

What is the acronym for the "Medical Group Management Association"?

300

A bill that uses several commonly used ICD-10 codes

What is a "Superbill"?

400

This program is intended to increase access to primary care in rural communities, to receive certification, they must be located in rural, undeserved areas.

What is a "Rural Health Clinic" (RHC)?

400

Prior to submitting claims, the organization/technology scrubs a claim and checks for errors then electronically transmits claim information that is compliant with HIPAA standards.

What is a "Clearinghouse"?

400

This term refers to an entity or a private company that has a contract with CMS to determine and to pay part A and some part B bills, such as bills from hospitals, on a cost basis and to perform other related functions

What is a "Fiscal Intermediary" (FI)?

400

This is sometimes required by a patient’s insurance company to determine medical necessity, but does not guarantee benefits will be paid

What is "Pre-Certification"?

400

Tracking of dollars not submitted to payers; when claims are tracked to make sure they are submitted to meet filing requirements, measured by how many "days" of revenue are sitting in the total unbilled

What is "Unbilled A/R"?

400

A calculation that compares the Total Outstanding A/R to Average Daily Revenue

What is "Gross Days Revenue or Receivables Outstanding" (GDRO)?

400

A payment file sent back to the provider

What is an "835" file?

400

AHIMA

What is the acronym for the "American Health Information Management Association"?

400

A unique physician identification number, discontinued in 2007 and replaced by NPI

What is the "UPIN"?

500

This acronym describes a "Skilled Nursing Facility"

What is a "SNF"?

500

The use of electronic information and telecommunications technologies to support long-distance clinical health care

What is "Telehealth"?

500

This term refers to a request for additional documentation on the claim

What is an "Additional Development Request" (ADR)?

500

This is also known as a waiver of liability, and is a notice a provider should give you before your receive a service.

What is an "Advanced Beneficiary Notification" (ABN)?

500

An alphabetical list of accounts receivable with outstanding balances

What is an "Aged Trial Balance"?

500

A calculation that compares Total A/R Aged over 90 days to Total Accounts Receivable


What is "Aging Over 90 Days"?

500

A claims acknowledgement from an inquiry

What is a "277" file?

500

A 10-digit provider id number

What is the "NPI"?

600

They make up more than half of all hospitals in the United States, they provide essential access to inpatient, outpatient and emergency services in rural communities

What is a "Rural Hospital"?

600

This software aims to rid medical claims of errors and omissions

What is a "Claims Scrubber"?

600

This systems allows you to check Medicare beneficiary eligibility data in real-time and is used to prepare accurate Medicare claims, determine beneficiary liability, or check eligibility for specific services

What is "HIPAA Eligibility Transaction System" (HETS)?

600

This is a medical billing term to describe the employee who is a part of a group policy  

What is a "Subscriber"?

600

An institutional paper claim form

What is the "UB04"?

600

An inquiry transaction about a claim

What is a "276" file?

600

A summary of daily patient treatments, charges and payments received

What is a "Day Sheet"?

700

The prices that hospitals get paid from Medicare for certain services. CAHs receive different reimbursement given their designation otherwise. 


What is the "Prospective Payment System" (PPS)?

700

This is a method where Medicare signals back to provider that they are going to reject a claim, and therefore, allows the opportunity to fix before final adjudication

What is "Return to Provider" (RTP)?

700

A confirmation of coverage

What is "Eligibility"?

700

Used by hospitals and healthcare centers when submitting bills to Medicare and 3rd party payors for reimbursement

What is the "UB04"?

700

A file that contains information regarding the Patient Information Transaction set

What is a "275" file?

700

Standardized code sets that are necessary for Medicare and other health insurance providers to provide healthcare claims that are managed consistently and in an orderly manner

What is the "HCPCS"?

800

This is a healthcare program that supports low-income families or individuals

What is "Medicade"?

800

A notice you receive from Medicare explaining the benefits received and not received

What is the "EOB or EOMB"?

800

HIPPA-compliant files requesting eligibility details for a patient

What is a "271" file?

800

An editor from the government that edits a variety dimensions/facets of a claim

What is the "OCE"?

900

A system that helps get claims out to secondary payers faster

What is "Accelerated Secondary Billing" (ASB)?

900

A professional paper claim form

What is the "CMS 1500"?

900

A file returned to Epic

What is a "CRD" file?

900

The local coverage determination and editing system from CMS

What is the "LCD"?

1000

Any information in a medical record that can be used to identify an individual

What is "Protected Health Information" (PHI)?

1000

The HIPPA electronic transaction standards, replaced 4010

What is a "5010" file?

1000

A unique number that identifies the patients’ medical record

What is the "MRN"?

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