Revenue cycle stages, prospective payment systems, and reimbursement methodology terminology for health information management.
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- What is the "revenue cycle" in healthcare?
- The entire process of managing claims, payments, and revenue generation from patient registration to final payment
- What is typically the first step in the healthcare revenue cycle?
- Patient scheduling and pre-registration
- What does the term "charge capture" refer to?
- Recording all billable services and supplies provided to a patient during an encounter
- What is a "chargemaster" (CDM)?
- A comprehensive list of billable items and services with their associated charges maintained by a healthcare facility
- What does the term "clean claim" mean?
- A claim submitted without errors that can be processed without additional information from the provider
- What is a "claim scrubber"?
- Software that checks claims for errors before submission to reduce denials
- What is a "claim denial"?
- A payer's refusal to reimburse a submitted claim, in whole or in part
- What is the term for the process of investigating and correcting a denied claim?
- Denial management (appeals process)
- What does the acronym DRG stand for?
- Diagnosis-related group
- What payment system uses DRGs to reimburse hospitals for inpatient care?
- The Inpatient Prospective Payment System (IPPS)
- What does "prospective payment system" mean?
- A payment method that sets predetermined reimbursement rates before services are rendered, based on classification systems
- What payment classification system is used under the Outpatient Prospective Payment System (OPPS)?
- Ambulatory Payment Classifications (APCs)
- What case-mix classification system is used for skilled nursing facility Medicare reimbursement?
- The Patient Driven Payment Model (PDPM)
- What payment model is used for home health agency Medicare reimbursement?
- The Patient Driven Groupings Model (PDGM), under the Home Health Prospective Payment System
- What government agency administers Medicare and Medicaid?
- The Centers for Medicare and Medicaid Services (CMS)
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