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level: Revenue Cycle Finance

Questions and Answers List

level questions: Revenue Cycle Finance

Question	Answer
cataloging system for diagnosis codes that track various health interventions taken by medical professionals.	International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM)
cataloging system for procedural codes that track various health interventions taken by medical professionals.	International Classification of Diseases, 10th Revision, Procedure Coding System (ICD-10-PCS)
A coding classification system in which codes are used to bill outpatient procedures and physician services.	Healthcare Common Procedure Coding System (HCPCS) "LEVEL 1"
A coding classification system in which codes are used to bill professional services, supplies, and products.	Healthcare Common Procedure Coding System (HCPCS) "LEVEL 2"
A coding classification system used to report professional services and procedures provided to a patient at ambulatory care centers, medical clinics, and other outpatient care facilities.	Current Procedural Terminology, 4th Edition (CPT-4)
has the ability to accurately generate medical codes directly from clinical documentation.	Computer Assisted Coding (CAC)
documentation that is meant to assist clinicians by minimizing time spent on documentation and maximizing time for patient care.	Point-Of-Care (POC) Documentation
promotes national correct coding methodologies and reduces improper coding which may result in inappropriate payments of Medicare Part B claims and Medicaid claims.	National Correct Coding Initiative (NCCI)
this database can determine the number of days of coverage the subscriber has by categories. such as for skilled nursing facilities and inpatient stays.	HIPAA Eligibility Transaction System (HETS)
a notice a provider should give you before you receive a service if, based on Medicare coverage rules, your provider has reason to believe Medicare will not pay for the service.	Advance Beneficiary Notice (ABN)
an explanation from a health plan to a provider about a claim payment.	Remittance Advice
of how the payment is to be applied to the patents accounts	Electronic Remittance Advice
It lets you know which healthcare provider has filed a claim on your behalf, what it was for, whether it was approved, and for how much.	Explanation Of Benefits
Software used to assign diagnosis and procedure codes.	Encoder
A request that a provider add documentation to the EHR to clarify a diagnosis or procedure that has been performed.	Physician Query
this form may include but not limited to patient identifiers, date of service, insurance identifiers, diagnosis codes, and descriptions.	Encounter Forms
encompasses the entire customer engagement and payment process from beginning to end.	Revenue Cycle
these cover the bulk of the healthcare procedures and services reimbursable under the Medicare Outpatient Prospective Payment Systems (OPPS)	Permanent National Codes
CDT codes are used to inform the dental payer of what procedures were performed.	Dental Codes
provide the means of reporting and tracking services and procedures until a more specific code is established.	Unlisted codes
are assigned to services and procedures that are under review before being included in the CPT coding system.	Temporary National Codes
a code that provides the means by which the reporting physician can indicate that a service or procedure that has been performed has been altered by some specific circumstance but has not changed in its definition or code.	Modifiers
a middle person or agency that makes sure data entry and/or coding will proceed properly by removing errors.	Scrubbers / Clearing House
An authorization request to determine medical necessity.	Formal Referral
An authorization request form that is completed and signed by a provider and given directly to a patient.	Direct Referral
When a provider informs a patient and requests the referring service provider to set a patient appointment.	Verbal Referral
When a physician refers their patient to another care site with which they have a financial relationship.	Self-Referral