Billing & Revenue Cycle

2. organization that accepts claims data from a healthcare organization, formats the claim, & submits it to the insurance company
5. finding out if the service is covered by the patient's plan
6. grouping transactions by _________ makes it easier to find entry errors when balancing daily transactions
7. notice of payment to the healthcare organization
10. managed care organization agrees to a set reimbursement amount per patient per month
12. for Medicare beneficiaries who need assistance with activities of daily living or have cognitive impairment
15. finding out if the payer considers a service medically necessary based on the patient's specific condition
16. gather demographics and insurance information
17. Centers for Medicare and Medicaid Services
18. determining the payer's reimbursement amount for the service
19. a collection of all charges and payments entered for a particular date or time period

1. a series of administrative functions that are required to capture & collect payment for services provided by a healthcare organization
3. contractual ________ eliminate any invalid dollar amounts from the outstanding account balance
4. process of ensuring the patient has the appropriate referral, precertification, predetermination, or preauthorization as needed
8. when claim is not paid due to error or due to not meeting requirements for medical necessity
9. intended to improve the traditional fee-for-service method by changing the focus to value-based care rather than volume-based care
11. _____ report is a list of outstanding balances from either patients or insurance companies
12. healthcare organizations may offer payment plans or discounts based on a ______ scale which allows the patient to pay a lower monthly rate depending on the debt-to-income ratio
13. the process by which the insurance carrier reviews the benefits and coverage and then either processes or denies the claim
14. an order from a provider for a patient to see a specialist or obtain specific medical services