Billing & Revenue Cycle

3. a series of administrative functions that are required to capture & collect payment for services provided by a healthcare organization
4. organization that accepts claims data from a healthcare organization, formats the claim, & submits it to the insurance company
9. finding out if the payer considers a service medically necessary based on the patient's specific condition
10. process of ensuring the patient has the appropriate referral, precertification, predetermination, or preauthorization as needed
14. contractual ________ eliminate any invalid dollar amounts from the outstanding account balance
15. a collection of all charges and payments entered for a particular date or time period
17. 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
18. the process by which the insurance carrier reviews the benefits and coverage and then either processes or denies the claim
19. determining the payer's reimbursement amount for the service

1. gather demographics and insurance information
2. finding out if the service is covered by the patient's plan
5. when claim is not paid due to error or due to not meeting requirements for medical necessity
6. intended to improve the traditional fee-for-service method by changing the focus to value-based care rather than volume-based care
7. notice of payment to the healthcare organization
8. managed care organization agrees to a set reimbursement amount per patient per month
11. Centers for Medicare and Medicaid Services
12. grouping transactions by _________ makes it easier to find entry errors when balancing daily transactions
13. an order from a provider for a patient to see a specialist or obtain specific medical services
16. _____ report is a list of outstanding balances from either patients or insurance companies
17. for Medicare beneficiaries who need assistance with activities of daily living or have cognitive impairment