Revenue Cycle
Terms Mean Things
Who’s Who
System Overload
Collections
100
This department submits the claim to the insurance company
Billing
100
These are known as:
Insurance cards
100
Small Balance Team Lead
Katherine Morgia
100
System used to verify if a claim has been billed.
SSI
100
The second-largest medical insurance provider by total members in the US.
Blue Cross
200
This department verifies the patient's information and insurance.
Registration
200
Family members of the policy holder, such as spouse, children or partner.
Dependent
200
Small Balance Team Manager
Nedra Brown
200
The web-based collections management and reporting platform, used by collectors to work accounts
Artiva Webstation/ Artiva Workstation
200
The amount owed for health care services before the health insurance begins to pay.
Deductible
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
HR Director - Shared Service Center Sarasota
Sheri Clark
300
Database used for the long-term storage of patient medical records.
HPF/MPF/Cerner-Powerchart
300
Before some services are covered, approval for services, which is based on medical necessity is required by the health plan.
Prior authorization
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.
A Claim
400
A/R Directors- Shared Service Center Sarasota
Cheril Mcginnis and Vicki Derenzis
400
System 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
AR/ 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
Vice President - Shared Service Center Sarasota
Christina Slemp
500
A private company that transmits and translates claim information from a health care provider to the payers (insurance company)
Clearinghouse
500
After all options to resolve an account have been made and the Denials team removes or reduces the account charges on the account.
Denial adjustment/ Write-off