HIT230 CH 3 INTRODUCTION TO
REVENUE MANAGEMENT
concurrent review - Answer-continued-stay review for continued appropriateness of care
and medical necessity of tests and procedures ordered during an inpatient
hospitalization.
data analysis - Answer-see data analytics.
data analytic - Answer-stools and systems that are used to analyze (examine and study)
clinical and financial data, conduct research, and evaluate the effectiveness of disease
treatments.
data mining - Answer-extracting and analyzing data to identify patterns, whether
predictable or unpredictable.
data warehouse - Answer-database that uses reporting interfaces to consolidate
multiple databases, allowing reports to be generated from a single request; data is
accumulated from a wide range of sources within an organization and is used to guide
management decisions.
day sheet - Answer-also called manual daily accounts receivable journal; chronological
summary used to manually track all transactions posted to individual patient
ledgers/accounts on a specific day.
discharge planning - Answer-involves arranging appropriate health care services for the
discharged patient (e.g., home health care).
discharged not final billed (DNFB) - Answer-patient claims that are not finalized because
of billing delays.
discharged not final coded (DNFC) - Answer-patient claims that are not finalized
because of coding delays or incomplete documentation.
encounter form - Answer-financial record source document used by providers and other
personnel to select treated/managed diagnoses and procedures/services provided to
the patient during the current encounter.
facility billing - Answer-see institutional billing.
guarantor - Answer-person responsible for paying health care fees.
institutional billing - Answer-involves generating UB-04 claims for charges generated for
inpatient and outpatient services provided by health care facilities, which according to
, CMS include hospitals, long-term care facilities, skilled nursing facilities, home health
agencies, hospice organizations, end-stage renal disease providers, outpatient physical
therapy/occupational therapy/speech pathology services, comprehensive outpatient
rehabilitation facilities, community mental health centers, critical access hospitals,
federally qualified health centers, histocompatibility laboratories, Indian Health Service
facilities, organ procurement organizations, religious non-medical health care
institutions, and rural health clinics.
integrated revenue cycle (IRC)combining revenue management with clinical, coding,
and information management decisions because of the impact on financial
management. - Answer-
manual daily accounts receivable journal - Answer-also called the day sheet; a
chronological summary of all transactions posted to individual patient ledgers/accounts
on a specific day.
metrics - Answer-standards of measurement, such as those used to evaluate an
organization's revenue cycle to ensure financial viability.
non-participating provider (nonPAR) - Answer-does not contract with the insurance plan;
patients who elect to receive care from nonPARs will incur higher out-of-pocket
expenses.
out-of-pocket payment - Answer-established by health insurance companies for a health
insurance plan; usually has limits of $1,000 or $2,000; when the patient has reached the
limit of an out-of-pocket payment (e.g., annual deductible) for the year, appropriate
patient reimbursement to the provider is determined; not all health insurance plans
include an out-of-pocket payment provision.
participating provider (PAR) - Answer-contracts with a health insurance plan and
accepts whatever the plan pays for procedures or services performed.
patient account record - Answer-also called patient ledger; a computerized or manual
permanent record of all financial transactions between the patient and the practice.
patient ledger - Answer-see patient account record.
preadmission certification (PAC)review for medical necessity of inpatient care prior to
the patient's admission. - Answer-
preadmission review - Answer-see preadmission certification.
preauthorization - Answer-health plan review that grants prior approval of patient health
care services.
precertification - Answer-see preauthorization.
REVENUE MANAGEMENT
concurrent review - Answer-continued-stay review for continued appropriateness of care
and medical necessity of tests and procedures ordered during an inpatient
hospitalization.
data analysis - Answer-see data analytics.
data analytic - Answer-stools and systems that are used to analyze (examine and study)
clinical and financial data, conduct research, and evaluate the effectiveness of disease
treatments.
data mining - Answer-extracting and analyzing data to identify patterns, whether
predictable or unpredictable.
data warehouse - Answer-database that uses reporting interfaces to consolidate
multiple databases, allowing reports to be generated from a single request; data is
accumulated from a wide range of sources within an organization and is used to guide
management decisions.
day sheet - Answer-also called manual daily accounts receivable journal; chronological
summary used to manually track all transactions posted to individual patient
ledgers/accounts on a specific day.
discharge planning - Answer-involves arranging appropriate health care services for the
discharged patient (e.g., home health care).
discharged not final billed (DNFB) - Answer-patient claims that are not finalized because
of billing delays.
discharged not final coded (DNFC) - Answer-patient claims that are not finalized
because of coding delays or incomplete documentation.
encounter form - Answer-financial record source document used by providers and other
personnel to select treated/managed diagnoses and procedures/services provided to
the patient during the current encounter.
facility billing - Answer-see institutional billing.
guarantor - Answer-person responsible for paying health care fees.
institutional billing - Answer-involves generating UB-04 claims for charges generated for
inpatient and outpatient services provided by health care facilities, which according to
, CMS include hospitals, long-term care facilities, skilled nursing facilities, home health
agencies, hospice organizations, end-stage renal disease providers, outpatient physical
therapy/occupational therapy/speech pathology services, comprehensive outpatient
rehabilitation facilities, community mental health centers, critical access hospitals,
federally qualified health centers, histocompatibility laboratories, Indian Health Service
facilities, organ procurement organizations, religious non-medical health care
institutions, and rural health clinics.
integrated revenue cycle (IRC)combining revenue management with clinical, coding,
and information management decisions because of the impact on financial
management. - Answer-
manual daily accounts receivable journal - Answer-also called the day sheet; a
chronological summary of all transactions posted to individual patient ledgers/accounts
on a specific day.
metrics - Answer-standards of measurement, such as those used to evaluate an
organization's revenue cycle to ensure financial viability.
non-participating provider (nonPAR) - Answer-does not contract with the insurance plan;
patients who elect to receive care from nonPARs will incur higher out-of-pocket
expenses.
out-of-pocket payment - Answer-established by health insurance companies for a health
insurance plan; usually has limits of $1,000 or $2,000; when the patient has reached the
limit of an out-of-pocket payment (e.g., annual deductible) for the year, appropriate
patient reimbursement to the provider is determined; not all health insurance plans
include an out-of-pocket payment provision.
participating provider (PAR) - Answer-contracts with a health insurance plan and
accepts whatever the plan pays for procedures or services performed.
patient account record - Answer-also called patient ledger; a computerized or manual
permanent record of all financial transactions between the patient and the practice.
patient ledger - Answer-see patient account record.
preadmission certification (PAC)review for medical necessity of inpatient care prior to
the patient's admission. - Answer-
preadmission review - Answer-see preadmission certification.
preauthorization - Answer-health plan review that grants prior approval of patient health
care services.
precertification - Answer-see preauthorization.
