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?
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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?
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Patient scheduling and pre-registration- What does the term "charge capture" refer to?
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Recording all billable services and supplies provided to a patient during an encounter- What is a "chargemaster" (CDM)?
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A comprehensive list of billable items and services with their associated charges maintained by a healthcare facility- What does the term "clean claim" mean?
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A claim submitted without errors that can be processed without additional information from the provider- What is a "claim scrubber"?
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Software that checks claims for errors before submission to reduce denials- What is a "claim denial"?
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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?
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Denial management (appeals process)- What does the acronym DRG stand for?
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Diagnosis-related group- What payment system uses DRGs to reimburse hospitals for inpatient care?
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The Inpatient Prospective Payment System (IPPS)- What does "prospective payment system" mean?
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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)?
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Ambulatory Payment Classifications (APCs)- What case-mix classification system is used for skilled nursing facility Medicare reimbursement?
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The Patient Driven Payment Model (PDPM)- What payment model is used for home health agency Medicare reimbursement?
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The Patient Driven Groupings Model (PDGM), under the Home Health Prospective Payment System- What government agency administers Medicare and Medicaid?
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The Centers for Medicare and Medicaid Services (CMS)
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