Study your flashcards anywhere!

Download the official Cram app for free >

  • Shuffle
    Toggle On
    Toggle Off
  • Alphabetize
    Toggle On
    Toggle Off
  • Front First
    Toggle On
    Toggle Off
  • Both Sides
    Toggle On
    Toggle Off
  • Read
    Toggle On
    Toggle Off

How to study your flashcards.

Right/Left arrow keys: Navigate between flashcards.right arrow keyleft arrow key

Up/Down arrow keys: Flip the card between the front and back.down keyup key

H key: Show hint (3rd side).h key

A key: Read text to speech.a key


Play button


Play button




Click to flip

25 Cards in this Set

  • Front
  • Back

Aging reports

A report which is run that indicate which claims are outstanding


Request for review of an insurance claim that has been underpaid


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


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


Center for Medicare and madicade services

Delinquent claim

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


Expansion of benefits


Health information portability and accountability act


Health maintenance organization


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


Known as a follow-up or tracer

Request made for a status of a claim

Lost claim

Insurance claim that can't be found


Supplemental insurance policy for Medicare beneficiary covers deductible and co payments


National provider identification


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


To assess how much payment should be made


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