Across
- 5. Medical code ranging from three to five digits that explains the medical condition of the patient
- 7. This is the standard claim form used for Hospital and other facilities
- 12. A system used to classify inpatient hospital stays into cost, utilization and complexity groups for the purposes of standardizing payments across the country
- 16. The major state based government insurance program for low income and disabled Americans
- 18. The process by which procedures and diagnoses are translated into a standardized set of numerical values to assist in the completion of the final bill
- 19. abbr a provision in a contract that applies when a person is covered under more than one group medical program it requires that payment of benefits be coordinated by all programs
- 20. The main purpose is to resubmit a claim when the payer indicates they have not received it - should not be used as a method to follow up on the status of a claim that has already been billed
- 21. Class of DRGs that were developed to reflect the clinical complexity of the overall patient population
- 22. Health insurance plans that limit the access and utilization of their subscriber's services to a defined or managed list of providers
- 23. Payment system where health care provider receives negotiated per member per month PMPM fee to provide care for enrollees-provider bears risk for costs above PMPM and reaps rewards for costs lower than PMPM
- 24. Front end revenue cycle is more formally called _____ which describes the processes before a patient receives services
- 25. The role of the primary point of contact and representative of the organization to patients and guarantors who have issues with their bills
- 26. What does SHC call money in the patient bucket
- 27. The amount of money the patient is responsible for before the healthcare coverage begins to pay for eligible benefits
Down
- 1. Electronic file sent by an insurer that includes payment and denial information for patient accounts
- 2. The major government health insurance program for Americans 65 and older and nonelderly people with disabilities
- 3. The Medicare Rule that states that if a patient receives outpatient services three days before a hospital admission, then the facility cannot bill MCR separately for the outpatient services as they are considered incidental to the inpatient services
- 4. A percentage discount to the billed charges presented on a claim
- 6. abbr Healthcare Common Procedure Coding System
- 8. Hospital and Payors use clinical decision support criteria to determine the appropriateness of care resource usage
- 9. abbr A system used to classify inpatient hospital stays into cost, utilization and complexity groups for the purposes of standardizing payments across the country
- 10. abbr a type of managed care organization whose providers have agreed with a payer or third party administrator to provide health care at reduced rates to the insurer's or administrator's clients
- 11. abbr Current Procedural Terminology codes-first level of the HCPCS coding system - five digit codes that are used primarily to identify medical services and procedures furnished by physicians and other health care professionals
- 13. abbr a written notice given by a provider to a MCR beneficiary advising him/her in advance that Medicare may not pay for a service and that he/she will be responsible for payment
- 14. An error free claim that is submitted to a payer for payment
- 15. The portion of cost the patient is responsible for and often applies after meeting the deductible requirements of their contract
- 17. is comprised of clinical documentation charge entry and charge reconciliation
- 25. abbr Office containing consolidated revenue cycle functions