Healthcare Billing & Revenue Cycle Management

Flashcards covering key vocabulary and concepts from the lecture notes on revenue cycle management, patient accounts, and healthcare billing practices.

Revenue Cycle

The process of managing the financial side of a medical business, including procedure service coding, charge capture, claim submission, billing, and payment collection.

Insurance Eligibility Verification

The process of confirming a patient's insurance coverage before an appointment or service is provided.

Practice Management System (PMS)

The administrative system used in a medical office for billing, demographics, insurance information, and other administrative tasks; part of the EHR.

Claim Submission

The process of sending a bill to the insurance company, either electronically or on paper, for services rendered.

Adjudication

The insurance company's process of reviewing medical claims for necessity and accuracy before making a payment.

Remittance Advice (RA)

A document from the insurance company to the practice that includes each code, the amount billed, and the amount paid or denied.

Explanation of Benefits (EOB)

A statement sent to the patient by the insurance company, explaining what was paid, what the patient owes, and how the claim was processed.

Bookkeeping

The process of recording financial transactions of a business, including accounts receivable and accounts payable.

Accounts Receivable

Money owed to the doctor's office by patients and insurance companies.

Accounts Payable

Bills that the doctor's office is responsible for paying.

Posting

Transferring information about co-payments, services, and procedures from one record to another in a patient's account.

CPT Code

A procedure code that identifies services and procedures performed on a patient.

HCPCS Code

A code that identifies services and procedures, including CPT codes (Level 1) and supplies, durable medical equipment, and injections (Level 2).

Visit Capture Screen

The electronic version of the encounter form or charge slip in an EHR system, where procedures and diagnostic codes are recorded.

Medical Record Number (MRN)

A unique identifier assigned to each patient by the EHR system, which can be letters, numbers, or a combination.

Debit

A charge added to an existing balance.

Credit

A payment subtracted from the existing balance.

Balance

The difference between the debit and credit in an account.

Encounter Form

A form listing the patient's name, record number, date of visit, and common procedures done in the office, along with their HCPCS or CPT codes; also known as a charge slip or super bill.

Patient Ledger

A complete record of all charges, services rendered, payments made, and adjustments for an individual patient account.

Adjustment

A change to a patient's balance, such as a write-off due to an error or other circumstance.

Day Sheet

A manual payment receipt journal for the day, recording all patient charges and receipts; used as a backup to electronic systems.

Cash Control Sheet

A daily record showing the total income of cash and checks, deposits made, and amounts not deposited.

Batch Journal

An electronic version of the day sheet used in practice management systems.

Concurrent Information

Information that is entered into the system and automatically updated across all integrated modules, such as EMR and practice management programs.

Cost Estimate Sheet

A document providing a breakdown of the estimated costs for a surgery or procedure, including surgeon fees, hospital costs, and other related expenses.

Professional Discount

A discount authorized by the provider, usually for other physicians, their families, or other medical professionals.