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The Medical Office Billing Process


LEARNING OUTCOMES

When you finish this chapter, you will be able to:

  • Describe the billing and reimbursement cycle in a medical office.
  • Discuss the type of information collected from patients.
  • Identify the major types of health plans.
  • Describe the information recorded about a patient’s office visit.
  • Discuss the process of adjudication.
  • Discuss the process required to balance a medical office’s accounts.
  • Explain the importance of collections in the medical office.

KEY TERMS

  • accounting cycle
  • accounts receivable (AR)
  • adjudication
  • billing cycle
  • capitation
  • coding
  • coinsurance
  • consumer-driven health plan (CDHP)
  • copayment
  • modifier
  • diagnosis
  • diagnosis code
  • encounter form
  • explanation of benefits (EOB)
  • fee-for-service
  • health maintenance organization (HMO)
  • health plan
  • managed care
  • medical coder
  • medical necessity
  • patient information form
  • payer
  • policyholder
  • practice management program (PMP)
  • preferred provider organization (PPO)
  • premium
  • procedure
  • procedure code
  • remittance advice (RA)
  • statement










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