Understanding Health Insurance, A Guide to Billing and Reimbursement, 14th Edition, Chapter 4 - Revenue Cycle Management | 80Questions and Answers(A+ Solution guide)

revenue cycle management - is the process by which health care facilities and providers ensure their financial viability by increasing revenue and enhancing the patient's experience account receivable management - also known as revenue cycle management Claims rejections - unpaid claims that fail to meet certain data requirements like missing data claim denials - unpaid claims that contain beneficiary identification errors utilization management - method of controlling health care costs and quality of care by reviewing the appropriateness and necessity of care provided to patients prior to administration of care prospective review - prior to care retrospective review - after care Preadmission Certification (PAC) - review for medical necessity of inpatient care prior to the patient's admission Preauthorization - Prior approval for treatment and procedures concurrent review - review for medical necessity of tests and procedures ordered during an inpatient hospitalization