Term
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Definition
- Occurs while patient still present
- Allows for collection of copay
- Shortens revenue cycle (charge posting complete at day’s end)
- Most commonly used in medical offices |
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Term
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Definition
- Similar to real-time posting except superbills are gathered into a batch for the date and posted later
- Often handled by a billing service which posts charges, generates insurance claims, and sends patient statements
- Common method for hospital billing |
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Term
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Definition
- Act as transaction intermediaries between providers and health plans
- Receive claims from provider, send them to plans, receive responses from plans, and send responses to provider (functions as a switch)
- May transmit PHI because they are one of the three covered entities defined by HIPAA |
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Term
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Definition
- Special software that examines claim data before it is sent to eliminate preventable billing errors
- May be component of billing system and thus help prevent claims from being created until errors corrected
- Or, may examine batch of claims and report errors prior to sending |
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Term
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Definition
| Begins with previous month’s balance and shows only charges or payments posted in current period. This is 1/2 type of payment staten |
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Term
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Definition
| Shows all unpaid items with payment, adjustments, and balance for each item. This is 1/2 type of payment staten |
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Term
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Definition
- Receive remittance information electronically from payer in ANSI 835 transaction
- Special segments carry codified information about how claim was adjudicated and any adjustments made to the payment
- Create report of what has been sent and how it has been applied to patient accounts |
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Term
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Definition
- Supplemental documents providing additional medical information to claims processor
- Include information that cannot be accommodated within claim format |
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Term
| Notice of Proposed Rule Making |
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Definition
Identifies six types of electronic claims attachments:
- Clinical reports
- Laboratory reports
- Emergency department reports
- Rehabilitative services
Medications (during treatment, upon discharge)
-Ambulance services |
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