Protected Health Information (PHI)

A professional paper claim form

Standardized code sets that are necessary for Medicare and other health insurance providers to provide healthcare claims that are managed cornsistently and in an orderly manne

A responsible party and/or insured party who is not necessarily the patient.

This is a subsystem of a hospital information system used for storing financial data, calculation healthcare costs, and providing billing information.

These are costs that are a patient's responsibility for hospitalization between day 61-90 days

An institutional paper claim form

An editor from the government that edits a variety dimensions/facets of a claim

This is sometimes required by a patient’s insurance company to determine medical necessity, but does not guarantee benefits will be paid

A payment file sent back to the provider

The United States federal government health insurance program for Americans who are 65 years of age or older

A notice you receive from Medicare explaining the benefits received and not received

A unique number that identifies the patients’ medical record

This is also known as a waiver of liability, and is a notice a provider should give you before your receive a service.

A claims acknowledgement from an inquiry

This is a method where Medicare signals back to provider that they are going to reject a claim, and therefore, allows the opportunity to fix before final adjudication

Outstanding charges that are the patient's responsibility that have not been successfully collected which are eventually written off and sent to a collection agency

The local coverage determination and editing system from CMS

This is a medical billing term to describe the employee who is a part of a group policy

A calculation that compares Total A/R Aged over 90 days to Total Accounts Receivable