The hospital billing process consists of all the functions performed to prepare charges for submission to patients and third party payers. The purpose of the process is to obtain reimbursement for services and items rendered by the hospital.

The _________________ process refers to the portion of billing that involves preparing claims for submission to payers.

The claim form that is generally used to submit facility charges for services provided in the hospital.

A four-digit code assigned in the charge master to each service or item provided by the hospital to designate the category of service.

Charges that represent the component of patient care services performed by physicians and other non-physician clinical providers.

Functions of the billing process include registration, posting of charges, chart review and coding, preparation of claim forms and patient invoices or statements for charge submission and monitoring of and follow-up on outstanding accounts.

The purpose of a ______________ ____________ is to submit charges to third party payers for reimbursement.

A written agreement between the hospital and a payer that outlines the terms and conditions of participation for the hospital and the payer.

The department in the hospital generally responsible for chargemaster maintenance.

The function that involves changes, revisions, and deletions of codes and incorporation of changes in payer guidelines in the chargemaster.

Participating provider agreements outline the terms and conditions of participation for hospitals and payers. Four common provisions covered in thes agreements include patient care services, billing requirements, reimbursement, and standards of medical c

Fee-for-service; fee schedule; percentage of accrued charges; and usual, customary, and reasonable (UCR) are examples of ________________ reimbursement methods.

Services that are considered reasonable and necessary to address the patient’s condition based on standards of medical practice.

Charges that represent cost and overhead for providing patient care services, including space, equipment, supplies, drugs and biologicals, and technical staff.

Two levels of codes in the HCPCS coding system.

The patient’s financial responsibility, as defined by the patient’s plan, may represent a deductible, coinsurance, and/or copayment amounts.

The ________________ ________________ _________________ _____________ reimbursement method calculates payment for charges accrued during a hospital stay based on a percentage of the approved charges.

The term that describes payer requirements regarding claim submission and the specified period that claims must be filed within after services are provided.

The systems that were developed to standardize descriptions of conditions, services, and items for the purpose of consistent reporting and tracking of procedures and conditions.

The computerized system that allows the recording of, storage of, processing of, and access to data by various departments simultaneously.

A claim that needs additional information and does not pass paper edits is a clean claim.

_________________ reimbursement methods base payments for health care services on charges submitted while _______________ ____________ methods are determined based on predetermined amounts.

The computerized system used by hospitals to inventory and record services and items provided in various locations in the hospital during a patient stay.

The organization that defines revenue code categories.

The physician who prepares orders for an inpatient admission.