Preclaims submission activities, claims processing activities, accounts receivable and claims reconciliation and collections
What is the components of the revenue cycle?
100
A hospital-specific internally assigned code use to identify an item or service
What is charge code?
100
An explanatory phrase that has been assigned to describe a procedure, service, or supply.
What is a charge description?
100
The provider can correct and resubmit the claim but cannot appeal the rejection
What is claim rejection?
100
RCM
What is revenue cycle management?
200
Comprise tasks and functions from the patient registration and case management areas
What is preclaims submission activities?
200
A hospital-specific number that is assigned to each clinical or ancillary department that provides services to patients and has at least one charge item in the CDM
What is department code?
200
The dollar amount that the hospital is charging for the item or service rendered to the patient
What is the charge(price)?
200
The provider cannot resubmit the claim but can appeal the denial
What is claim denial?
200
CDM
What is charge description master?
300
Include the capture of all billable services, claim generation, and claim corrections
What is claims processing activities?
300
A four-digit numeric code required for billing on the UB-04 claim form or the 8371 ETS.
What is revenue code?
300
Codes used by providers and facilities to identify or flag a service that has been modified in some way to provide more specific information about that procedure or service.
What is a modifier?
300
The provider can resubmit the claim once the problems are corrected
What is claim return to provider?
300
MAC
What is medicare administrative contractor?
400
Manages the amounts owed to a facility by customers who received services buy whose payments will be made at a later date by the patients or their third-party payer for reimbursement
What is accounts receivable?
400
The current code assigned by the AMA and CMS to be reported for individual services, procedures, and supplies rendered to the patient.
What is CPT/HCPCS code?
400
An identifier used to indicate whether a line item charge is currently being used by the facility to report a service or supply.
What is a charge status?
400
The claim is not returned to the provider, but it is not processed for payment until the fiscal intermediary makes a determination or obtains further informaiton
What is claim suspension?
400
EOB
What is explanation of benefits?
500
The healthcare facility uses the EOB, MSN, and RA to reconcile accounts
What is claims reconciliation and collection?
500
Charge Code, Department Code, Revenue Code, CPT?HCPCS Code.
What is revenue cycle coding?
500
Used to differentiate among payers that may have specific or special billing protocol in place.
What is payer identifier?
500
The claims can be processed for payment with some line item rejected for payment.