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25 Cards in this Set

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Aging reports

A report which is run that indicate which claims are outstanding

Appeal

Request for review of an insurance claim that has been underpaid

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

case rate

Averaging after a flat rate is given to certain category of procedures

Charges

the dollar amount a hospital bill an outlier case based on the itemized bill

CMS

Center for Medicare and madicade services

Delinquent claim

Insurance claim submitted to an insurance company and payment is over due

E.O.B

Expansion of benefits

HIPAA

Health information portability and accountability act

HMO

Health maintenance organization

Inpatient

A term used when a patient is admitted to the hospital for an overnight stay

Inquiry

Known as a follow-up or tracer


Request made for a status of a claim

Lost claim

Insurance claim that can't be found

Medicap

Supplemental insurance policy for Medicare beneficiary covers deductible and co payments

NPI

National provider identification

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

Over payment

Money paid over and above the amount the amount due buy the insurance for patient

Peer review

Review of patients case by 1 or more physicians to evaluate another physician

Per diem

A single charge for a day in the hospital regardless of any actual charges or cost incurred

Rebill (resubmit)

Send another request for payment for an overdue bill

Rejected claim

A claim that is discarded by the insurance company because of a technical error

Remittance advice RA

Document details service billed and describes payment determination

Review

To assess how much payment should be made

Scrubbing

The process in which computer software checks for errors before a claim is submitted to an insurance carrier for payment

Suspended claim

Claim that is held in a pended state because of ab error or needs more I information