Glossary (See related pages) A | B | C | D | E | F | G | H | I | J | K | L | M | N | O | P | Q | R | S | T | U | V | W | X | Y | Z           A ^ Back to Top ^ accounting cycle   the flow of financial transactions in a business accounts receivable (AR)   monies that are flowing into a business adjudication   series of steps that determine whether a claim should be paid adjustments   changes to patients’ accounts that alter the amount charged or paid administrative safeguards   administrative policies and procedures designed to protect electronic health information outlined by the HIPAA Security Rule aging report   a report that lists the amount of money owed to the practice, organized by the amount of time the money has been owed audit/edit report   a report from a clearinghouse that lists errors to be corrected before a claim can be submitted to the payer audit trail   a report that traces who has accessed electronic information, when information was accessed, and whether any information was changed autoposting   an automated process for entering information on a remittance advice (RA) into a computer         B ^ Back to Top ^ backup data   a copy of data files made at a specific point in time that can be used to restore data to the system billing cycle   regular schedule of sending statements to patients         C ^ Back to Top ^ capitated plan   an insurance plan in which payments are made to a physician by a managed care company for a patient who selects the physician as his or her primary care provider, regardless of whether the patient visits the physician capitation   advance payment to a provider that covers each plan member’s health care services for a certain period of time capitation payments   payments made to physicians on a regular basis (such as monthly) for providing services to patients in a managed care insurance plan case   a grouping of transactions for visits to a physician’s office, organized around a condition charges   amounts a provider bills for the services performed chart   a folder that contains all records pertaining to a patient chart number   a unique number that identifies a patient clearinghouse   a service company that receives electronic or paper claims from the provider, checks and prepares them for processing, and transmits them in HIPAA-compliant format to the correct carriers coding   the process of assigning standardized codes to diagnoses and procedures. coinsurance   part of charges that an insured person must pay for health care services after payment of the deductible amount collection agency   an outside firm hired to collect on delinquent accounts collection list   a tool for tracking activities that needs to be completed as part of the collections process Collection Tracer report   a tool for keeping track of collection letters that were sent consumer-driven health plan (CDHP)   a type of managed care in which a high-deductible/lowpremium insurance plan is combined with a pretax savings account to cover out-of-pocket medical expenses, up to the deductible limit copayment   A small fixed fee paid by the patient at the time of an office visit. cycle billing   a type of billing in which patients are divided into groups and statement printing and mailing is staggered throughout the month         D ^ Back to Top ^ database   a collection of related bits of information day sheet   a report that provides information on practice activities for a twenty-four-hour period diagnosis   physician’s opinion of the nature of the patient’s illness or injury diagnosis code   a standardized value that represents a patient’s illness, signs, and symptoms         E ^ Back to Top ^ electronic data interchange (EDI)   the exchange of routine business transactions from one computer to another using publicly available communications protocols electronic funds transfer (EFT)   a system that transfers money electronically electronic medical record (EMR)   electronic collection and management of health data electronic prescribing   the use of computers and handheld devices to write and transmit prescriptions to a pharmacy in a secure digital format electronic remittance advice (ERA)   an electronic document that lists patients, dates of service, charges, and the amount paid or denied by the insurance carrier encounter form   a list of the procedures and charges for a patient’s visit established patient   a patient who has been seen by a provider in the practice in the same specialty within three years explanation of benefits (EOB)   paper document from a payer that shows how the amount of a benefit was determined         F ^ Back to Top ^ fee-for-service   health plan that repays the policyholder for covered medical expenses fee schedule   a document that specifies the amount the provider bills for provided services filter   a condition that data must meet to be selected         G ^ Back to Top ^ guarantor   an individual who is not a patient of the practice, but who is the insurance policyholder for a patient of the practice         H ^ Back to Top ^ health maintenance organization (HMO)   a managed health care system in which providers agree to offer health care to the organization’s members for fixed periodic payments from the plan health plan   a plan, program, or organization that provides health benefits HIPAA (Health Insurance Portability and Accountability Act of 1996)   federal act that set forth guidelines for standardizing the electronic data interchange of administrative and financial transactions, exposing fraud and abuse in government programs, and protecting the security and privacy of health information. HIPAA Electronic Transaction and Code Sets standards   regulations requiring electronic transactions such as claim transmission to use standardized formats HIPAA Privacy Rule   regulations for protecting individually identifiable information about a patient’s past, present, or future physical and mental health and payment for health care that is created or received by a health care provider HIPAA Security Rule   regulations outlining the minimum administrative, technical, and physical safeguards required to prevent unauthorized access to protected health care information         I ^ Back to Top ^ information technology (IT)   development, management, and support of computer-based hardware/software systems insurance aging report   a report that lists how long a payer has taken to respond to insurance claims         K ^ Back to Top ^ knowledge base   a collection of up-to-date technical information         M ^ Back to Top ^ managed care   a type of insurance in which the carrier is responsible for both the financing and the delivery of health care medical coder   a person who analyzes and codes patient diagnoses, procedures, and symptoms medical necessity   treatment provided by a physician to a patient for the purpose of preventing, diagnosing, or treating an illness, injury, or its symptoms in a manner that is appropriate and provided in accordance with generally accepted standards of medical practice MMDDCCYY format   a specific way in which dates must be keyed, in which “MM” stands for the month, “DD” stands for the day, “CC” represents the century, and “YY” stands for the year modifier   a two-digit character that is appended to a CPT code to report special circumstances involved with a procedure or service MultiLink codes   groups of procedure code entries that relate to a single activity         N ^ Back to Top ^ National Provider Identifier (NPI)   a standard identifier for all health care providers consisting of ten numbers navigator buttons   buttons that simplify the task of moving from one entry to another new patient   a patient who has not received services from the same provider or a provider of the same specialty within the same practice for a period of three years         O ^ Back to Top ^ Office Hours break   a block of time when a physician is unavailable for appointments with patients Office Hours schedule   a listing of time slots for a particular day for a specific provider once-a-month billing   a type of billing in which statements are mailed to all patients at the same time each month         P ^ Back to Top ^ packing data   the deletion of vacant slots from the database patient aging report   a report that lists a patient’s balance by age, date and amount of the last payment, and telephone number patient day sheet   a summary of patient activity on a given day patient information form   form that includes a patient’s personal, employment, and insurance data needed to complete an insurance claim patient ledger   a report that lists the financial activity in each patient’s account, including charges, payments, and adjustments patient statements   a list of the amount of money a patient owes, organized by the amount of time the money has been owed, the procedures performed, and the dates the procedures were performed payer   private or government organization that insures or pays for health care on the behalf of beneficiaries payment day sheet   a report that lists all payments received on a particular day, organized by provider payment plan   an agreement between a patient and a practice in which the patient agrees to make regular monthly payments over a specified period of time payment schedule   a document that specifies the amount the payer agrees to pay the provider for a service, based on a contracted rate of reimbursement payments   monies received from patients and insurance carriers physical safeguards   mechanisms required to protect electronic systems, equipment, and data from threats, environmental hazards, and unauthorized intrusion policyholder   a person who buys an insurance plan; the insured practice analysis report   a report that analyzes the revenue of a practice for a specified period of time, usually a month or a year practice management program (PMP)   a software program that automates many of the administrative and financial tasks required to run a medical practice preferred provider organization (PPO)   managed care network of health care providers who agree to perform services for plan members at discounted fees premium   the periodic amount of money the insured pays to a health plan for insurance coverage primary insurance carrier   the first carrier to whom claims are submitted procedure   medical treatment provided by a physician or other health care provider procedure code   a code that identifies a medical service procedure day sheet   a report that lists all the procedures performed on a particular day, in numerical order prompt payment laws   state laws that mandate a time period within which clean claims must be paid; if they are not, financial penalties are levied against the payer protected health information (PHI)   information about a patient’s past, present, or future physical or mental health or payment for health care that can be used to identify the person purging data   the process of deleting files of patients who are no longer seen by a provider in a practice         R ^ Back to Top ^ rebuilding indexes   a process that checks and verifies data and corrects any internal problems with the data recalculating balances   the process of updating balances to reflect the most recent changes made to the data record of treatment and progress   a physician’s notes about a patient’s condition and diagnosis referring provider   a physician who recommends that a patient see a specific other physician remainder statements   statements that list only those charges that are not paid in full after all insurance carrier payments have been received remittance advice (RA)   an explanation of benefits transmitted electronically by a payer to a provider restoring data   the process of retrieving data from backup storage devices         S ^ Back to Top ^ sponsor   in TRICARE, the active-duty service member standard statements   statements that show all charges regardless of whether the insurance has paid on the transactions statement   a list of all services performed for a patient, along with the charges for each service         T ^ Back to Top ^ technical safeguards   automated processes used to protect data and control access to data tickler   a reminder to follow-up on an account         U ^ Back to Top ^ uncollectible account   an account that does not respond to collection efforts and is written off the practice’s expected accounts receivable         W ^ Back to Top ^ walkout statement   a document listing charges and payments that is given to a patient after an office visit         X ^ Back to Top ^ X12-837 Health Care Claim (837P)   HIPAA standard format for electronic transmission of a professional claim from a provider to a health plan
	To learn more about the book this website supports, please visit its Information Center. 2009 McGraw-Hill Higher Education Any use is subject to the Terms of Use and Privacy Notice. McGraw-Hill Higher Education is one of the many fine businesses of The McGraw-Hill Companies.

		Log In You must be a registered user to view the premium content in this website. If you already have a username and password, enter it below. If your textbook came with a card and this is your first visit to this site, you can use your registration code to register. Username: Password: Forgot your password?

		Site Preferences (Log out) Send mail as: TA email: Other email: "Floating" navigation? Drawer speed:

		Notes (What is this?)      Add a note 1. (optional) Enter a note here: 2. (optional) Select some text on the page (or do this before you open the "Notes" drawer). 3. Highlighter Color: NoneYellowRedGreenBlue 4.

		Search Search for: Search in: This siteThe web (PowerSearch)

Home > Glossary

Course-wide Content Medisoft v14 Data Files Glossary End-of-Chapter Workshe...

Choose a ChapterChapter 1Chapter 2Chapter 3Chapter 4Chapter 5Chapter 6Chapter 7Chapter 8Chapter 9Chapter 10Chapter 11Chapter 12Chapter 13Chapter 14Chapter 15

Instructor Resources Instructors Manual Test Bank Computerized Test Bank PowerPoint Presentations Medisoft CMS1500 & UB04 Forms Course-wide Content Medisoft v14 Data Files Glossary End-of-Chapter Workshe...

Choose a ChapterChapter 1Chapter 2Chapter 3Chapter 4Chapter 5Chapter 6Chapter 7Chapter 8Chapter 9Chapter 10Chapter 11Chapter 12Chapter 13Chapter 14Chapter 15