26 relations: American National Standards Institute, Centers for Medicare and Medicaid Services, Claims adjuster, Clinical coder, Co-insurance, Copayment, Deductible, Electronic data interchange, Electronic health record, Electronic remittance advice, Explanation of benefits, Group purchasing organization, Health care in the United States, Health insurance, Health Insurance Portability and Accountability Act, Medical classification, Medical necessity, Medical practice management software, Medical record, Medically Unlikely Edit, National Uniform Billing Committee, Optical character recognition, Out-of-pocket expense, Physician, Revenue Cycle Management, Software.
The American National Standards Institute (ANSI) is a private non-profit organization that oversees the development of voluntary consensus standards for products, services, processes, systems, and personnel in the United States.
The Centers for Medicare & Medicaid Services (CMS), previously known as the Health Care Financing Administration (HCFA), is a federal agency within the United States Department of Health and Human Services (HHS) that administers the Medicare program and works in partnership with state governments to administer Medicaid, the Children's Health Insurance Program (CHIP), and health insurance portability standards.
Claims adjuster (claim adjuster), or claims handler (claim handler), investigates insurance claims by interviewing the claimant and witnesses, consulting police and hospital records, and inspecting property damage to determine the extent of the company's liability.
A clinical coder – also known as clinical coding officer, diagnostic coder, medical coder or medical records technician – is a health information professional whose main duties are to analyse clinical statements and assign standard codes using a classification system.
Coinsurance in insurance, is the splitting or spreading of risk among multiple parties.
A copayment or copay is a fixed amount for a covered service, paid by a patient to the insurance company before patient receives service from physician.
In an insurance policy, the deductible is the amount paid out of pocket by the policy holder before an insurance provider will pay any expenses.
Electronic data interchange (EDI) is the concept of businesses electronically communicating information to that which was traditionally communicated on paper.
An electronic health record (EHR), or electronic medical record (EMR), is the systematized collection of patient and population electronically-stored health information in a digital format.
An electronic remittance advice (ERA) is an electronic data interchange (EDI) version of a medical insurance payment explanation.
An explanation of benefits (commonly referred to as an EOB form) is a statement sent by a health insurance company to covered individuals explaining what medical treatments and/or services were paid for on their behalf.
In the United States, a group purchasing organization (GPO) is an entity that is created to leverage the purchasing power of a group of businesses to obtain discounts from vendors based on the collective buying power of the GPO members.
Health care in the United States is provided by many distinct organizations.
Health insurance is insurance that covers the whole or a part of the risk of a person incurring medical expenses, spreading the risk over a large number of persons.
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) was enacted by the United States Congress and signed by President Bill Clinton in 1996.
Medical classification, or medical coding, is the process of transforming descriptions of medical diagnoses and procedures into universal medical code numbers.
Medical necessity is a United States legal doctrine, related to activities which may be justified as reasonable, necessary, and/or appropriate, based on evidence-based clinical standards of care.
Medical practice management software (PMS) is a category of healthcare software that deals with the day-to-day operations of a medical practice.
The terms medical record, health record, and medical chart are used somewhat interchangeably to describe the systematic documentation of a single patient's medical history and care across time within one particular health care provider's jurisdiction.
A Medically Unlikely Edit (MUE) is a US Medicare unit of service claim edit applied to Medical claims against a procedure code for medical services rendered by one provider/supplier to one patient on one day.
The National Uniform Billing Committee (NUBC) is the governing body for forms and codes use in medical claims billing in the United States for institutional providers like hospitals, nursing homes, hospice, home health agencies, and other providers.
Optical character recognition (also optical character reader, OCR) is the mechanical or electronic conversion of images of typed, handwritten or printed text into machine-encoded text, whether from a scanned document, a photo of a document, a scene-photo (for example the text on signs and billboards in a landscape photo) or from subtitle text superimposed on an image (for example from a television broadcast).
In North American financial context an out-of-pocket expense (or out-of-pocket cost) is the direct outlay of cash that may or may not be later reimbursed from a third-party source.
A physician, medical practitioner, medical doctor, or simply doctor is a professional who practises medicine, which is concerned with promoting, maintaining, or restoring health through the study, diagnosis, and treatment of disease, injury, and other physical and mental impairments.
Revenue cycle management is the process used by healthcare systems in the United States to track the revenue from patients, from their initial appointment or encounter with the healthcare system to their final payment of balance.
Computer software, or simply software, is a generic term that refers to a collection of data or computer instructions that tell the computer how to work, in contrast to the physical hardware from which the system is built, that actually performs the work.