General Ledger Cash
Petty cash used as payments for miscellaneous purchases
Electronic Funds Transfer (EFT)
The transfer of funds from payer to
... [Show More] payee through the banking system. It is considered the quickest way to move money because it is possible to transfer funds between banks on the same day.
Electronic Remittance Advice (ERA)
A standardized healthcare claim payment format used to electronically send third-party payment details to healthcare providers.
ERA Level 1
Electronic receipt of 835 data only. An ERA is received, the info is printed, and the printout is processed the same as a paper remittance.
ERA Level 2
Electronic receipt of 835 dataset and electronic data entry. ERA data is received and entered into the computer electronically, then viewed in a terminal.
ERA Level 3
Electronic receipt, data entry, reconciliation, posting, and closing of 835 data.
ERA Level 4
Total automation of receipt, data entry, payment posting, and adjustment processing of 835 data. Includes all of level 3 and linking of banking information to allow reconciliation of payments received electronically though a non-bank network, with funds received electronically.
Credit Balances
When payments and contractual adjustments posted to an account exceed the overall total charges.
CMS-838
Medicare form used to report all Medicare credit-balance overpayment accounts on a quarterly basis.
Technical Denials
Type of health plan denial based on missing or incomplete claim information.
Clinical Denials
Type of health plan denial associated with the care or service provided.
Underpayment denials
When the health plan pays less than the agreed contract amount.
Pre-service denials
Associated with Physicians, Patient Access, Financial Counselors, and Case Management. Examples include not obtaining pre-auth, insurance benefits not verified, incorrect data entry.
Time-of-service Denials
Associated with Physicians, Patient Access, Case Management, Clinical Service departments, and HIM.
Examples include New technology used without determining coverage, Charges bundled or unbundled incorrectly, Patient acuity level changes but the type of service not changed, admission notification not completed, or invalid coding
Post-Service Denials
Associated with the Clinical Service departments, Patient Access, IT, and Patient Accounting
Examples include late charges, duplicate claims, and untimely filing.
Recovery Audit Contractors (RAC)
Mission is to protect Medicare from fraudulent and abusive billing.
Beneficiary Appeal Type
Filed by the Medicare beneficiary who is dissatisfied with the government's claim determination.
Provider Appeal Type
Filed by the provider. When the amount in question is between $1,000 and $10,000, a provider may request a hearing. If the amount is >$10k the provider may file the appeal with the Provider Reimbursement Review Board. [Show Less]