MEDICAL BILLING TERMINOLOGY
QUESTIONS AND ANSWERS WITH
SOLUTIONS 2024
72 Hour rule - ANSWER Hospital coding rule for Medicare beneficiaries that allows outpatient services
performed within 72 hours of an inpatient admission to be reported on the claim as part of the inpatient
stay so long as the services are related to the inpatient stay; also known as the three-day window rule.
Accounts Receivable (AR) - ANSWER Accounts Receivable is the total of all balances owed by patients or
insurance companies regardless of delinquency.
Aging - ANSWER The classification of accounts receivable by the amount of time they are past due.
Allowed Charge - ANSWER The charge amount an insurance company considers being fair payment for a
service or supply.
Allowed Days - ANSWER The number of days a patient is approved for medical services.
Applied Amount - ANSWER The portion of payment "applied" to a particular charge.
Base rate - ANSWER The rate which is calculated based on a hospital's costs, wage index, and location,
and is used in determining what a hospital will be paid for a particular DRG.
Crossovers - ANSWER When a primary carrier will pass the claim and primary payment information on to
the secondary carrier automatically, it is called a crossover or crossover claims. This is most common
when Medicare is the primary payer.
Crosswalk - ANSWER A comparison or map of the codes for the same or similar classifications under two
coding systems; it serves as a guide for selecting the closest match.
Electronic Data Interchange (EDI) - ANSWER Transmission of claims and other information from one
device to another.
QUESTIONS AND ANSWERS WITH
SOLUTIONS 2024
72 Hour rule - ANSWER Hospital coding rule for Medicare beneficiaries that allows outpatient services
performed within 72 hours of an inpatient admission to be reported on the claim as part of the inpatient
stay so long as the services are related to the inpatient stay; also known as the three-day window rule.
Accounts Receivable (AR) - ANSWER Accounts Receivable is the total of all balances owed by patients or
insurance companies regardless of delinquency.
Aging - ANSWER The classification of accounts receivable by the amount of time they are past due.
Allowed Charge - ANSWER The charge amount an insurance company considers being fair payment for a
service or supply.
Allowed Days - ANSWER The number of days a patient is approved for medical services.
Applied Amount - ANSWER The portion of payment "applied" to a particular charge.
Base rate - ANSWER The rate which is calculated based on a hospital's costs, wage index, and location,
and is used in determining what a hospital will be paid for a particular DRG.
Crossovers - ANSWER When a primary carrier will pass the claim and primary payment information on to
the secondary carrier automatically, it is called a crossover or crossover claims. This is most common
when Medicare is the primary payer.
Crosswalk - ANSWER A comparison or map of the codes for the same or similar classifications under two
coding systems; it serves as a guide for selecting the closest match.
Electronic Data Interchange (EDI) - ANSWER Transmission of claims and other information from one
device to another.
