Which is a computerized permanent record of all financial transactions between the patient and the practice?

PROCESSING AN INSURANCE CLAIM

the processing of an insurance claim is initiated when the patient contacts a healthcare provider's office and schedules an appointment.

is the insurance claim used to report professional and technical services.

the provider agrees to accept what the insurance company allows or approves as payment in full for the claim.

ACCOUNTS RECEIVABLE MANAGEMENT

assists providers in the collection of appropriate reimbursement for services rendered, and include the following:

• Insurance  verification and eligibility
• Patient and family counseling about insurance and payment issues
• Patient and family assistance with obtaining community resources
• Preauthorization of services
• Capturing charges and posting payments
• Billing anf claims submission
• Account follow-up anf payment resolution

PARTICIPATING PROVEDER (PAR)

contracts with a health insurance plan and accepts whatever the plan pays for procedures or services performed.

NONPARTICIPATING PROVIDER (nonPAR)

(or out-of-network provider)

does not contract with the insurance plan, and patients who elect to receive care from nonPARs will incur higher out-of-pocket expenses.

PATIENT REGISTRATION FORM

is used to create the patient's financial and medical records.

is the insurance plan responsible for paying healthcare insurance claims first (80 percent of billed amount).

states that the policyholder whose birth month and day occurs earlier in the calendar year holds the primary policy for dependent children(if both have same birthday, policy in effect the longest is considered primary).

some self-funded healthcare plans use the gender rule, which states that the father's plan is always primary when a child is covered by both parents.

is the financial record source document used by healthcare providers and other personnel to record treated diagnoses and services rendered to the patient during the current encounter (in physician's office it's called a

, in a hospital it's called a

). 

PATIENT LEDGER, known as the PATIENT ACCOUNT RECORD

in a computerized system, is a permanent record of all financial transactions between the patient and the practice.

MANUAL DAILY ACCOUNTS RECEIVABLE JOURNAL, also known as the DAY SHEET

is a chronologic summary of all transactions posted to individual patient ledgers/accounts on a specific day.

is the electronic or manual transmission of claims data to payers or clearinghouses for processing.

is a public or private entity that processes or facilitates the processing of nonstandard data elements into standard data elements (e.g., electronic claim).

VALUE-ADDED NETWORK (VAN)

is a clearinghouse that involves value-added vendors, such as banks, in the processing of claims.

ELECTRONIC FLAT FILE FORMAT (or electronic media claim)

which is a series of fixed-length records (e.g., 25 spaces for patient;s name) submitted to payers as a bill for healthcare services.

ELECTRONIC DATA INTERCHANGE (EDI)

is the computer-to-computer transfer of data between providers and third-party payers is the computer-to-computer transfer of data between providers and third-party  (or providers and healthcare clearinghouses) in a data format agreed upon by sending and receiving parties.

which contains all required data elements needed to process and pay the claim (e.g., valid diagnosis and procedure/service codes, modifiers, and so on).

is a set of supporting documentation or information associated with a healthcare claim or patient encounter.

COORDINATION of BENEFITS (COB)

is a provision in group health insurance policies intended to keep muptiple insurers from paying benefist covered by other policies.

sorting claims upon submission to collect and verify information about the patient and provider.

process in which the claim is compared to payer edits and the patient's health plan benefits to verify that the:

• Required information is available to process the claim.
• Claim is not a duplicate.
• Payer rules and procedures have been followed.
• Procedures performed or services are covered benefits.

any procedure or service reported on the claim that is not included on the master benefit list.

that the payer requires the provider to obtain preauthorization before performing certain procedures and services, and because it was not obtained, the claim is denied(rejected).

which is an abstract of all recent claims filed on each patient.

the maximum amount the payer will allow for each procedure or service, accourding to the patient's policy.

the total amount of covered medical expenses a policyholder must pat each year out-of-pocket before the insurance company is obligated to pay any benefit.

is the percentage the patient pays for covered services after the deductible has been met and the copayment has been paid.

ELECTRONIC REMITTANCE ADVICE (ERA)

a remittance advice submitted to the  provider electronically.

ELECTRONIC FUNDS TRANSFER (EFT)

payers deposit funds to the provider's account electronically.

routing slip, charge slip, encounter form, or super bill, from which the insurance claim was generated.

are organized by month and insurance compamy and have been submitted to the payer, but processing is not complete.

are filed according to year and insurance company and include those for whick all processing, including appeals, has been completed.

are organized according to date of service because payers often report the results of insurance claims processed on different patients for the same date of service and proveder. this mass report is called a batched remittance advice

organized by year and are generated for providers who do not accept assignment.

documented as a letter signed by teh provider explaining why a claim should be reconsidered for payment.

any medical condition that was diagnosed and/or treated within a specified period of time immediately preceding the enrollee's effective date of coverage.

are the amounts owed to a business for services or goods provided.

PAST-DUE ACCOUNT (or DELINQUENT ACCOUNT

is one that has not been paid within a certain time frame (e.g., 120 days).

have not been paid within a certain time frame (also about 120 days).

advances through aging periods (e.g., 30 days, 60 days, 90 days, and so on), and providers typically focus internal recover efforts on older delinquent claims (e.g., 120 days or more).

ACCOUNTS RECEIVABLE AGING REPORT

shows the status (by date) of outstanding claims from each payer, as well as payments due frompatients.

account receivable that connot be collected by the porvider or a collection agency.`

Which is a computerized permanent record of all financial transactions between the patient and the practice quizlet?

Which form is considered a financial source document?

Which is an electronic format supported for health care claims transactions?

What is the computer to computer transfer of data between providers and healthcare clearinghouses called?