Electronic claims
Insurance Problem Solving
Collection Strategies
Healthcare Facilities
Billing Healthcare Facilities
100
The file is sent securely to the payer, often through a clearinghouse
What is transmission
100
systematic process by which healthcare providers manage all functions that capture, process, and collect patient service
What is Revenue Cycle Management?
100
Communication being sent by electronic media and computer billing reference to an outstanding account
What is Dun Messages
100
created to standardize medical education, improve physician training, and promote ethical medical practice across the United States
What is the American Medical Association (AMA)
100
refer to any medical care delivered without admitting the patient to a hospital overnight.
What is outpatient services
200
computer to computer exchange of standardized business documents in a structured electronic format
What is Electronic Data Interchange (EDI)
200
pays for costs not fully covered by your primary insurance plan
What is Secondary Insurance
200
Documentation that needs clarification as to why it is recommended
What is Medical Necessity Letter
200
United States-based nonprofit organization that evaluates and accredits more than 22,000 healthcare organizations and programs across the U.S., including hospitals, clinics, and nursing homes
What is the Joint Commission (TJC)
200
the process of translating diagnoses, procedures, and services provided to patients these are standardized billing codes such as ICD‑10‑CM, CPT, and HCPCS for reimbursement and compliance.
What is outpatient diagnosis coding
300
Healthcare is a company that hosts, manages and delivers software applications
What is Application Service Provider (ASP)
300
is a statement from your health insurance company that explains how a medical claim was processed, showing what was billed, what the insurer paid, and what you may owe, but it is not a bill
What is an Explanation of Benefits
300
what actions are taken when a debtor who has moved and left no forwarding address
What is Tracing
300
Its mission focuses on improving patient outcomes, safeguarding standards of care, and fostering an optimal practice environment
What is the American College Association
300
code assigned to the procedure that is performed for definitive treatment rather than for diagnostic or exploratory purposes, or which is necessary to address a complication
What is a Principal Procedure
400
Health Care common procedure coding system for non CPT procedures, including implants, supplies and certain services.
What is HCPCS
400
Report that details what is owed to the provider from insurance
What is an Aging Report (AR)
400
reduced fees, no charge, professional courtesy, financial hardship
What are Adjustments
400
operated directly by the Department of Defense. They are the core of the MHS and provide both inpatient and outpatient care, including specialized and sub-specialized services
What is Military and Voluntary hospitals
400
It is specifically designed for institutional billing, meaning it is used by hospitals, skilled nursing facilities, home health agencies, rehabilitation centers, hospice providers, and outpatient departments to report facility-level charges
What is a UB-04
500
To Confirm coverage
What is Prio-Authorization/Eligibility
500
What plan requires pre-authorization/referral
What is an HMO plan
500
face to face collection credit and debit cards, payment by check
What are Collecting fees
500
requires hospitals to bundle all outpatient diagnostic services and any related outpatient non‑diagnostic services provided
What is the 72 hour rule
500
is used by healthcare professionals such as physicians, therapists, and clinics to submit for services rendered to patients
What is a CMS-1500