Terms : Hide Images
| 9399778454 | Account Ledger | Account Statement | 0 | |
| 9399778455 | Accounts Receivable | Money that is flowing into a business | 1 | |
| 9399778456 | Adjudication | A series of steps that determine whether a claim should be paid. | 2 | |
| 9399778457 | Adjustment | Changes to a patients accounts that alter the amount charged or paid. | 3 | |
| 9399778458 | Advisory Opinions | Opinion issued by CMS or OIG that becomes legal advice. | 4 | |
| 9399778459 | Appellant | The person filing the appeal (provider or patient) aka claimant. | 5 | |
| 9399778460 | Audit | A formal review designed to judge whether the practice complies with billing and coding regulations. | 6 | |
| 9399778461 | Bad Debt | An account deemed uncollectible | 7 | |
| 9399778462 | Balance Billing | Collecting the difference between a provider's usual fee and a payer's lower allowed charge from the insured. | 8 | |
| 9399778463 | Bankruptsy | Legal declaration that a person is unable o pay his or her debts. | 9 | |
| 9399778464 | Billing/Collections Manager | A physician, practice administrator, office manager, or collections manager that create and implement collections policies, and monitor results of collections activities. | 10 | |
| 9399778529 | Bundled codes | 11 | ||
| 9399778465 | CCI Edits | Apply to medicare claims that bill for more than one procedure performed on the same patient; the same date of service. | 12 | |
| 9399778466 | Claim Adjustment group code | Codes used by a payer on an RA to indicate the general type of reason code for an adjustment. | 13 | |
| 9399778467 | Downcode | payer's review and reduction of a procedure code. | 14 | |
| 9399778468 | bad debt | an account deemed uncollectible | 15 | |
| 9399778469 | bankruptcy | legal declaration that a person is unable to pay his or her debts | 16 | |
| 9399778470 | collection agency | outside firm hired by a practice or facility to collect overdue accounts from patients | 17 | |
| 9399778471 | collections | the process of following up on overdue accounts | 18 | |
| 9399778472 | collections specialist | administrative staff member with training in proper collections techniques | 19 | |
| 9399778473 | credit bureau | organizations that supply information about consumers' credit history and relative standing | 20 | |
| 9399778474 | credit reporting | analyzing a person's credit standing during the collections process | 21 | |
| 9399778475 | cycle billing | type of billing in which patients with current balances are divided into groups to even out statement printing and mailing throughout a month, rather than mailing all statements once a month | 22 | |
| 9399778476 | day sheet | in a medical office, a report that summarizes the business day's charges and payments, drawn from all the patient ledgers for the day | 23 | |
| 9399778477 | embezzlement | stealing of funds by an employee or contractor | 24 | |
| 9399778478 | Equal Credit Opportunity Act (ECOA) | law that prohibits credit discrimination on the basis of race, color, religion, national origin, sex, marital status, age, or because a person receives public assistance | 25 | |
| 9399778479 | Fair and Accurate Credit Transaction Act (FACTA) | law designed to modify the Fair Credit Reporting Act to protect the accuracy and privacy of credit reports | 26 | |
| 9399778480 | Fair Debt Collection Practices Act (FDCPA) of 1977 | law regulating collection practices | 27 | |
| 9399778481 | guarantor billing | billing system that groups patient bills under the insurance policyholder; the guarantor receives statements for all patients covered under the policy | 28 | |
| 9399778482 | means test | process of fairly determining a patient's ability to pay | 29 | |
| 9399778483 | nonsufficient fund (NSF) check | a check that is not honored by the bank because the account lacks funds to cover it; also called a "bounced", "returned", or "bad" check | 30 | |
| 9399778484 | patient aging report | a report grouping unpaid patients' bills by the length of time that they remain due, such as 30, 60, 90, or 120 days | 31 | |
| 9399778485 | patient refunds | monies that are owed to patients | 32 | |
| 9399778486 | patient statement | a report that shows the services provided to a patient, total payments made, total charges, adjustments, and balance due | 33 | |
| 9399778487 | payment plan | patient's agreement to pay medical bills over time according to an established schedule | 34 | |
| 9399778488 | prepayment plan | payment before medical services are provided | 35 | |
| 9399778489 | retention schedule | a practice policy that governs which information from patients' medical records is to be stored, for how long it is to be retained, and the storage medium to be used | 36 | |
| 9399778490 | skip trace | the process of locating a patient who has not paid on an outstandingbalance | 37 | |
| 9399778491 | Telephone Consumer Protection Act of 1991 | federal that regulates consumer collections to ensure fair and ethical treatment of debtors; governs calling hours and methods | 38 | |
| 9399778492 | Truth in Lending Act | federal law requiring disclosure of finance charges and late fees for payment plans | 39 | |
| 9399778493 | uncollectible accounts | monies that can not be collected from the practice's payers or patients and must be written off | 40 | |
| 9399778494 | The Financial Policy | A written document that both staff members and patients can follow: -Clear, thoroughly written -Explains pt responsibility -Signed by new pts -Explained to to employees & pts | 41 | |
| 9399778495 | Financial Polices | Addresses all possible scenarios: -Financial arrangements and payment plans -Payments not covered by insurance -Various special circumstances | 42 | |
| 9399778496 | Patient Financial Education | -Post signs -Hand outs (brochures/flyers) -Verbal discussions | 43 | |
| 9399778497 | Patient Statements | Notices sent to patients explaining balance due via mail or email. -Automatically generated by PMP when insurance payments are done -Charges SHOULD be clearly itemized -Co-pay, deductible, co-insurance, non-covered services, fees (returned checks, missed appointments, forms) | 44 | |
| 9399778498 | Cycle Billing | Type of billing that divides patients w/ current balances into groups to even out monthly statement printing & mailing. | 45 | |
| 9399778499 | Guarantor Billing | Billing system that groups patients' bills according to the responsible party. | 46 | |
| 9399778500 | Patient Accounts Receivable | Collections (Patient A/R) Balance = Nice (Patient Satisfaction) Mean (Cash Flow) | 47 | |
| 9399778501 | Collections Specialists | Staff members trained in proper collections techniques. May receive bonuses for reducing patient A/R numbers. | 48 | |
| 9399778502 | Reasons for Non-Payment | -Can't -Broke -Forgot / Don't feel like it -Dissatisfied -Misunderstand their obligations | 49 | |
| 9399778503 | Embezzlement | Stealing by employees. | 50 | |
| 9399778504 | Avoiding Embezzlement | -Divide up the work -Bond insurance against theft | 51 | |
| 9399778505 | Consumer Collection Laws | The FTC enforces the FDCPA of 1977 and the TCPA of 1991. -NJ State / www.njconsumeraffairs.gov | 52 | |
| 9399778506 | Fair Trade Commission | FTC | 53 | |
| 9399778507 | Fair Debt Collection Practices Act | FDCPA (1977) | 54 | |
| 9399778508 | Telephone Consumer Protection Act | TCPA (1991) | 55 | |
| 9399778509 | FTC RULES | -1 Phone call per day -Between 8am - 9pm -No threats or profanity -3 voicemails per week (do not mention debt) -Identifiy the caller, practice & purpose of the call (no misleading patient) -Do not duscuss patient's debt w/ another person -If a patient requests no more calls, do not call (Instead, contact them via mail) -If a patient wants calls to be made to attorney, do not contact the patient directly again unless the attorney says to or can not be reached. -No Mail Postcards (duh) | 56 | |
| 9399778510 | Collection Procedures | Medical office tracks overdue bills by reviewing the patient aging report. Each practice follows a different process for collections. -Current or up-to-date: 30 days (bill patient) -Past due: 31-60 days (reminder notice, phone calls) -Past due: 61-90 days (collection letters) -Past due: More than 90 days (turn over to collections) | 57 | |
| 9399778511 | Patient Aging Report | Primary collections tool - Lists outstanding balances by length of time due | 58 | |
| 9399778512 | Collection Ratio | Average number of days it takes to convert outstanding accounts to paid accounts. Lower = Better | 59 | |
| 9399778513 | Phone Call Strategies | -Document all calls -Don't be robotic sounding -Don't use a script -Make calls in private -Maintain a positive & professional attitude -Never lose your cool | 60 | |
| 9399778514 | Payment Plans | Patient's agreement to pay medical bills according to a schedule. Practices have guidelines for appropriate time frames and minimum payment amounts for payment plans. (Prepayment or past due balances) | 61 | |
| 9399778515 | Equal Credit Opportunity Act | ECOA | 62 | |
| 9399778516 | ECOA | Prohibits credit discrimination on the basis of: race, color, religion, national origin, sex, marital status, age, or because a person receives public assistance. | 63 | |
| 9399778517 | Legal Reasons to Determine Credit Worthiness | -Income Amount -Expenses -Credit History | 64 | |
| 9399778518 | Federal Truth in Lending Act | Applies to payment plans for over 4 installments or plans w/ finance charges/interest. Requires Signed disclosure -APR (annual percentage rate) -Finance Charge (in dollar amount) -Amount Finances -Total of Payments -Payment Schedule | 65 | |
| 9399778519 | Collection Agencies | Outside firm (external company) hired to collect overdue accounts. Should be written into the financial policy. Cease all collection activities once collection agency takes over. -Most are paid a percentage of collected amounts. -Can buy unpaid accounts. -Credit Reporting | 66 | |
| 9399778520 | Credit Reporting | Analysis of a person's credit standing during the collections process (3 bureaus who track debts) | 67 | |
| 9399778521 | Skip Trace | Process of locating a patient who has an outstanding balance | 68 | |
| 9399778522 | Tracing a Debtor | -Contact the post office -Search telephone directories for relatives -Search the web at one of the free person-finding services -Examine publicly available state & federal records for contact info. | 69 | |
| 9399778523 | Uncollectible Accounts | Money that can not be collected and must be written off. -Small Balances -Old Balances -Very Poor Patients -Write Off Balances Classified as "Bad Debt" -Means Test It is fraud to write off balances for patients who do have the ability to pay | 70 | |
| 9399778524 | Means Test | Process of fairly determining a patient's ability to pay. | 71 | |
| 9399778525 | Patient Dismissals | Telling the patient they can no longer come to the practice. Dismissal Reason Examples: -Non-payment -Not Following Medical Instructions -Lying -Becomes Violent | 72 | |
| 9399778526 | Patient Dismissal Requirements | -Send a certified letter -Give 30 day notice -Provide referrals to other doctors -Be Tactful | 73 | |
| 9399778527 | Bankruptcy | A legal declaration of a person's inability to pay their debts. | 74 | |
| 9399778528 | Fair Credit Reporting Act | FCRA | 75 | |
| 9399778530 | Patient billing and collections, last step in billing and reimbursement process involves: | - Generating and mailing patient statements showing patient balances owed. - Posting patients' payment' - Examining aging reports for patients' accounts & handling collections | 76 | |
| 9399778531 | Patient Financial Responsibility - defined in the Financial Policy of the Medical practice - they address all scenarios including: | - financial arrangements & payment plans - payments not covered by insurance - various special circumstances | 77 | |
| 9399778532 | Policies should handle: | - collection of copayments, deductibles & past-due balances - financial arrangements for unpaid balances - charity care or use of sliding scale for those w/ low incomes - payments for services not covered by insurance - prepayment for services - day-of-service discounts/ discount to those in financial need - acceptance of cash, checks, money orders & credit or debit cards - special circumstances for auto accidents & nonassigned insurance | 78 | |
| 9399778533 | Effective patient billing includes: | educating patinets from the start of the billing & reimbursement process. | 79 | |
| 9399778534 | Patient Information Form | often presents a statement about payment responsibility (see pg 563) | 80 | |
| 9399778535 | Encounter to Claim amount due process | Patient Encounter visit charges (transactions) entered in patient ledger patient's balance is updated claim is filed resulting payment from patient's insurance carrier is posted, based on the RA/EOB | 81 | |
| 9399778536 | Resulting info. from RA/EOB | 1. payer's payment for each procedure is entered 2. Amount patient owes for each reported procedure is calculated 3. If any part of a charge needs to be written off d/t payer's required adjustment, this amount is also entered. | 82 | |
| 9399778537 | PMP uses the RA/EOB information to | update the day sheet and patient ledger | 83 | |
| 9399778538 | Day sheet | report summarizing the business day's charges and payments (recorded in the PMP) | 84 | |
| 9399778539 | Patient Statements | printed bills that show the amount each patient owes; computer generated from day sheet and patient ledger / both of these records have screens in the Practice's PMP | 85 | |
| 9399778540 | Patient Ledger Cards | manually generated bills that show the amount each patient owes; | 86 | |
| 9399778541 | Patient statements must be: | accurate and easy to read... clearly stating: - general info about the practice - cost breakdown of all services provided - date of statement & due date of payment (sometimes) - balances owed - Accepted methods of payment Clear and accuracy ensure patients pay on time | 87 | |
| 9399778542 | payment Cards | accepted from patient at time of service... patient then receives a zero balance statement | 88 | |
| 9399778543 | Guarantor Billing | grouping patient billing under the insurance policyholder. i.e. all of the family's recent charges can be categorized and sent together on one statement. (good for families w/ minor children) | 89 | |
| 9399778544 | Cycle billing | used to assign patient accounts to a specific time of the month and to standardize the times when statements will be mailed and payments will be due. i.e. if cycle is weekly, the patient accounts are divided into four groups / 1/4 of the bills go out each week. | 90 | |
| 9399778545 | Advantages/ Disadvantages of Guarantor Billing | - reduces amt. of time & $ spent on billing by reducing paper & mailing costs & reducing time spent on billing follow-up for those w/ overdue bills; fewer bills to track - Can become difficult & cumbersome when family members have various health plans and / or secondary plans | 91 | |
| 9399778546 | Collections | all the activities related to patient accounts and follow-up; they should achieve a suitable balance between maintaining patinet satisfaction & generating cash flow | 92 | |
| 9399778547 | Billing Collectors may have these job functions: | - Billing / collections manager - patient account representative (bookkepper) - Collections specialist | 93 | |
| 9399778548 | Billing / Collections Manager | - responsible for establishing office policies & enabling collections specialists to successfully perform their jobs. Create, implement, monitor, organize & develop, assist with, train, supervise & evaluate all that has to do with collections. | 94 | |
| 9399778549 | Collection Specialists | staff member with training in proper collections techniques, trained to work directly with the pratice's patients to resolve overdue bills. Must always act ethically, professionally... they represent the practice. | 95 | |
| 9399778550 | Embezzlement | stealing of funds by an employee or contractor - Dividing collections tasks among several people with helps reduce chances of employee errors or embezzlement | 96 | |
| 9399778551 | Avoiding opportunities for fraud | dividing tasks and responsibilities among several different people | 97 | |
| 9399778552 | Fair debt Collection practices Act (FDCPA) of 1977 | laws regulating collection practices Regulated by the Federal Trade Commission | 98 | |
| 9399778553 | Telephone Consumer Protection Act of 1991 | law regulating consumer collections to ensure fair and ethical treatment of debtors Regulated by the Federal Trade Commission | 99 | |
| 9399778554 | Collections from patients are | 1. classified as consmer collections 2. regulated by federal and state laws | 100 | |
| 9399778555 | FTC Guidelines outlined in FDCPA and Telephone Consumer Protection Act: | - contact patients 1x/day only; leave no more than 3 messages per week - do not call before 8am or after 9pm - do not threaten or use foul language - identify the caller, practice & purpose of call; don't mislead the patient - don't discuss debt with anyone but patient - no messages or emails detailing the debt owed - contact via email if patient requests calls stop - make calls to attorney if patient wishes, | 101 | |
| 9399778556 | patient aging reports | - contains patient's name - most recent payment - remaining balance DIVIDES information into categores based on each statement's beginning date: 1. Current or up to date (36 days) 2. Past Due (31-60 days) 3. Past Due: (61-90 days) 4. Past Due (90+ days) | 102 | |
| 9399778557 | Claims Under Appeal | denied claim that's being appealed may not convert the account to 'past-due' status until the final appeal decision has been received. | 103 | |
| 9399778558 | Each practice sets its own procedures for collections process. | 30 days.............bill patient 45 days.............call patient regarding bill 60 days.............letter 1 75 days.............letter 2 & call 80 days ............letter 3 90 days..............turn over to collections | 104 | |
| 9399778559 | Collections Letters | professional courteous, breif & to the point; Letter is first notice that their bill is past due. Gradually become more aggressive in wording. | 105 | |
| 9399778560 | Methods of Collections | Collections Letter (s) Collections Calls Documentation (specialists use abbreviations for common call results & situations) | 106 | |
| 9399778561 | Credit Arrangements & Payment Plans | Two federal laws govern payment arrangements: 1. Equal Credit Opportunity Act (ECOA) 2. Truth in Lending Act | 107 | |
| 9399778562 | Equal Credit Opportunity Act (ECOA) | prohibits credit discrimination on the basis of race, color, religion, national oirgin, sex, marital status, age, or because a person receives public assistance. (enforced by FTC) | 108 | |
| 9399778563 | Truth in Lending Act | law requiring disclosure of finance charges and late fees for payment plans; | 109 | |
| 9399778564 | Payment Plan | A practice may decide to extend credit to patients thu a PAYMENT PLAN that lets patients pay bills over time, rather than in a single payment.... practices may charge interest on these plans... terms must be agreed on by both parties. | 110 | |
| 9399778565 | Truth in Lending Act as it applies to Payment Plans | all terms must be disclosed and agreed upon before arragnement is finalized. If interest charged, or 4+ payments to be made plan is governed by TRUTH in LENDING ACT... part of the consumer Credit protection Act. | 111 | |
| 9399778566 | Credit Counseling & Debt Management programs | nonprofit organizations that can assist patients who are struggling to pay their bills or who have a great number of different bills; they contact creditors to work out payment plans at reduced costs to patients.... only 1 monthly payment made & then divided among creditors as agreed. | 112 | |
| 9399778567 | Payment Plan Design | practices have guidelines for appropriate time frames and minimum payment amounts for payment plans. | 113 | |
| 9399778568 | prepayment Plans | payment before major expensive procedures are performed... downpayment made & then monthly postpayments set up. | 114 | |
| 9399778569 | Collection Agencies and PHI | agencies must agree to follow practice's security & privacy policies to protect patients' PHI. - Employees of Coll. Agencies must sign confidentiality agreements regarding PHI | 115 | |
| 9399778570 | When to Use a Collection Agency | - All attempts to contact patient have been unsuccessful & patient hasn't responded to letters or calls - patient says they won't pay a bill - bad check for lack of funds - defaults on payment plan - outdated patient contact info./ can't be located - patient receives payment for service from insurance company & hasn't paid provider | 116 | |
| 9399778571 | Notice of Privacy Practices (NPP)- and Collections | explains practice's policy on when accounts are sent to an outside collector. | 117 | |
| 9399778572 | Collection Agency.... | be careful choosing... they represent the Practice. Choose a fair, ethical agency. ; Cost efficient way to retrieve some/all unpaid balances to cover some of practice's fees. | 118 | |
| 9399778573 | Types of Collection Agencies | Local, regional or national scale; Local or regional understand patient's demographic surroundings National has more tools to locate/contact debtors, often at lower cost | 119 | |
| 9399778574 | Credit Reporting | analysis of a person's credit standing during the collections process.... supplied by credit bureau for a cost.... shows record of unpaid bills/debt regulated by law under the Fair Credit Reporting Act (FCRA) and the Fair and Accurate Credit Transaction (FACTA) | 120 | |
| 9399778575 | Credit Bureaus | organizations that supply information about consumers' credit history | 121 | |
| 9399778576 | Fair Credit Reporting Act (FCRA) | law requiring consumer reporting agencies to have reasonable and fair procedures | 122 | |
| 9399778577 | Fair and Accurate credit Transaction Act (FACTA) | laws designed to protect the accuracy and privacy of credit reports. Amended FCRA in 2003. | 123 | |
| 9399778578 | FCRA and FACTA | designed to protect privacy of credit report information. | 124 | |
| 9399778579 | Red Flags Rule | law stating that health care entitles must estabilsh reasonable policies and procedures for implementing the identity theft guidelines. | 125 | |
| 9399778580 | Examples of red flags | alerts or warnings from consumer reporting agencies, suspicious personal identifying information and documents (photo ID), | 126 | |
| 9399778581 | Skip Tracing | process of locating a patient who has an outsanding balance. | 127 | |
| 9399778582 | Methods of Skip Tracing | Tracing a Debtor (practice searches) Professional Skip Tracing Assistance (for large practices) Computerized Skip Tracing (online directories & databases- less expensive) Effective Skip Tracing Calls | 128 | |
| 9399778583 | Bad Debt | Patient Account deemed uncollectible... | 129 | |
| 9399778584 | Uncollectible Account / Write-off account | monies that cannot be collected and must be written off / practice must determine which debts to write off in the PMP and whether to continue to treat the patients. | 130 | |
| 9399778585 | Means Test | process of fairly determining a patient's ability to pay... patient fills out a form and their income tax forms are reviewed, along with credit reports. | 131 | |
| 9399778586 | Bankruptcy | declaration that a person is unable to pay his or her debts / another reason for write-off. | 132 | |
| 9399778587 | Dismissing patients who do not pay | physician has the right to terminate the physician-patient relationship for any reason under the regulations of each state. | 133 | |
| 9399778588 | Patient Refunds | money that needs to be returned to patients when the practice has overcharged a patient for a service; | 134 | |
| 9399778589 | Patients' refunds or credit balances | are handled differently than insurance overpayments, which must be refunded to the payer. | 135 | |
| 9399778590 | Retention Schedule | protects both the provider & the patient; record must be available for anyone within or outside of the practice who is caring for the patient. - kept in case of legal proceedings | 136 | |
| 9399778591 | Practice Briefs | American Health Info. Management Assoc. publishes guidelines called practice briefs on many topics including retention of health information. | 137 |
