Revenue Cycle
The source document used by providers to record treated diagnoses and services rendered to the patient.
Encounter form
Supporting documentation or information associated with a claim.
Claims attachment
This is added to a CPT code to clarify procedures or indicate procedures have been altered.
Modifier
This is the person responsible for paying health care costs.
Guarantor
This is the fixed amount patients pay each time they receive services.
Copayment
The provider agrees to what the insurance company allows or approves as payment in full for the claim.
Accept assignment
This type of claim contains all the required information for processing.
ICD-10-CM codes contain ___ characters, and CPT codes contain ___ characters.
3-7, 5
The amounts owed to a business for services or goods provided.
Accounts receivable
The total amount the patient must pay in a year before insurance reimburses all remaining charges.
Out-of-pocket maximum
The patient authorizes the payer to reimburse the provider directly.
Assignment of Benefits
This type of claim is returned to the provider due to errors, missing information, or coverage issues.
Denied claim
On a CMS-1500 claim, we must link ______ to ______ to justify medical necessity.
CPT codes to ICD-10-CM
This entity performs centralized claims processing for providers and health plans.
Clearinghouse
This stage of the claim cycle involves comparing the claim to payer edits and the patient's health plan benefits.
Adjudication
Provide an example of coinsurance.
Insurance pays 80%, patient pays 20%.
This is used to identify healthcare providers in standard transactions.
NPI
ICD-10-CM is a classification system for ______ and _______.
Morbidity and mortality
This is a financial record for the patient.
Patient ledger or patient account record
When someone is covered by multiple health plans, this process intends to keep multiple insurers from paying benefits covered by other plans.
Coordination of Benefits
A Participating Provider (PAR) must accept ______ as payment for procedures or services performed.
Whatever a payer allows as reimbursement.
The legal name of a business practice.
Billing entity
Name all sections of the CPT. Double points if they are in the correct order.
Evaluation and Management (E/M), Anesthesia, Surgery, Radiology, Pathology and Laboratory, Medicine
Name the four stages of the insurance claim cycle, in order.
Submission, processing, adjudication, payment
_______ is a notice sent to the patient detailing the results of processing a claim. _______ is sent to the provider containing payment information about a claim.
Explanation of benefits, remittance advice