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