Administrative Assisting: Perform Charge Reconciliation

Vocabulary flashcards covering charge reconciliation, revenue cycle concepts, incentive models, accounts receivable, and auditing methods for administrative medical assistants.

Reconciliation

The process of ensuring that all accounts are balanced and accurate, reflecting updated balances, payments, adjustments, and final patient financial obligations.

Revenue Cycle

All finance-related aspects of a health care organization, encompassing every step from verifying patient eligibility to ensuring the appropriate reimbursement is collected.

Incentive Models

Value-based reimbursement programs transitioning from fee-for-service (FFS) that incorporate incentives or disincentives based on provider performance in quality measures, clinical outcomes, and patient satisfaction.

Accounts Receivables (A/R)

Any amount of money anticipated to be paid to a health care organization, including billed medical services awaiting payment.

A/R Aging Report

A financial report utilized to track outstanding balances so that older debts can be addressed first and potential collections from delinquent accounts can be identified.

Contractual Adjustment

The difference between the billed amount and the allowed amount for medical services, or any write-off amount recorded on the patient account.

Health Record Auditing

The process of reviewing documentation to ensure it is complete, correct, and signed by the provider, confirming that clinical details support the reported codes (e.g., CPT, HCPCS, and ICD-10-CM).

Prospective Audit

An internal audit performed prior to billing to ensure coding and billing accuracy, aid in detecting potential fraud or abuse, and verify that all rendered services are properly billed.

Retrospective Review

An audit conducted after claims have been billed, performed internally for statistical or quality purposes or externally by a third-party payer.

Concurrent Review

A type of audit performed at inpatient facilities during a patient's stay to ensure documentation completeness and the efficacy of treatment.