Random
Patient who received same-provider services within the last 3 years.
established patient
A set amount determined by the plan/payer that the patient pays for specified services, usually office visits and emergency department visits.
copayment
When a patient has a scheduled appointment and does not show up or contact the medical office.
no-show
Meeting the stipulated requirements to participate in the health care plan.
eligibility
Engaging with the sender regarding the message and the intended interpretation (e.g., focus solely on the conversation, do not interrupt, confirm the message speaker has said, be respectful and professional).
active listening
A record of the diagnosis and procedures covered during the current visit; also known as superbill.
encounter form
A report that lists outstanding balances that have not been paid by either the patient or the insurance payer.
aging report
Scheduling patients in groups with common medical needs.
clustering
The amount that must be paid before benefits are paid by the insurance company.
deductible
Beliefs that are not proven by facts about someone or a particular group of individuals.
biases
Information that includes follow-up appointments, provider orders, instructions, educational resources, and financial account information.
after-visit summary (AVS)
An organization that accepts the claims data from a health care provider, performs edits comparable to payer edits, and submits clean claims to the third-party payer.
clearinghouse
A type of scheduling in which two or more patients are scheduled within the same time slot.
double-booking
Healthcare Common Procedure Coding System codes that identify supplies and procedures not described by CPT codes.
HCPCS codes
Communication that occurs through expressive behaviors and body language rather than oral or written words.
nonverbal communication
Reasonable and appropriate services based on clinical standards per CMS and the OIG.
medical necessity
The percentage of the allowed amount the patient will pay once the deductible is met.
coinsurance
A federal agency that oversees the Medicare program and assists states with Medicaid programs.
Centers for Medicare & Medicaid Services (CMS)
International Classification of Diseases, 10th revision, Clinical Modification (ICD-10-CM) codes based on the provider’s diagnosis (why the patient is in need of medical services).
diagnosis codes
Being respectful by using proper verbiage, tone, and manners when conveying information.
telephone etiquette
A sample of written correspondence or email that is established with appropriate components that will be personalized to fit the need of the sender.
templates
Current Procedural Terminology codes that identify medical services and procedures performed by a provider.
CPT codes
The designed time frame for appointments based on the method of appointment durations.
matrix
A record of the diagnosis and procedures covered during the current visit; also known as superbill.
encounter form
The attitude, behavior, and work that represent a profession.
professionalism