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25 Cards in this Set
- Front
- Back
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Aging reports |
A report which is run that indicate which claims are outstanding |
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Appeal |
Request for review of an insurance claim that has been underpaid |
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Capitation |
The system of payment used by managed care plans in which physicionsn and hospitals are paid a fixed per capita amount for each patient enrolled over a stated period Of time regardless of the type of number of services provided |
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case rate |
Averaging after a flat rate is given to certain category of procedures |
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Charges |
the dollar amount a hospital bill an outlier case based on the itemized bill |
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CMS |
Center for Medicare and madicade services |
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Delinquent claim |
Insurance claim submitted to an insurance company and payment is over due |
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E.O.B |
Expansion of benefits |
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HIPAA |
Health information portability and accountability act |
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HMO |
Health maintenance organization |
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Inpatient |
A term used when a patient is admitted to the hospital for an overnight stay |
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Inquiry |
Known as a follow-up or tracer Request made for a status of a claim |
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Lost claim |
Insurance claim that can't be found |
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Medicap |
Supplemental insurance policy for Medicare beneficiary covers deductible and co payments |
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NPI |
National provider identification |
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Outpatient |
A patient who receives services in a health care facility such as a physician office clinic urgent care center ER or ambulatory surgical center and goes home the same day |
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Over payment |
Money paid over and above the amount the amount due buy the insurance for patient |
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Peer review |
Review of patients case by 1 or more physicians to evaluate another physician |
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Per diem |
A single charge for a day in the hospital regardless of any actual charges or cost incurred |
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Rebill (resubmit) |
Send another request for payment for an overdue bill |
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Rejected claim |
A claim that is discarded by the insurance company because of a technical error |
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Remittance advice RA |
Document details service billed and describes payment determination |
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Review |
To assess how much payment should be made |
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Scrubbing |
The process in which computer software checks for errors before a claim is submitted to an insurance carrier for payment |
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Suspended claim |
Claim that is held in a pended state because of ab error or needs more I information |
