Accounts receivable (AR)
Total outstanding charges awaiting payment. AR can be expressed as gross or net. Gross AR is the total, nondiscounted, charges awaiting payment. Net AR is the total charges awaiting payment, discounted for expected adjustments (see later).
Nonpayment credits that reduce the AR. Adjustments may include the following: disallowances, bad debt write-offs, small balance write-offs, courtesy adjustments, charge corrections, and timely filing limit write-offs.
Aged trail balance report (ATB), also aging report
Billing report that lists remaining AR amounts from historic periods. ATB reports typically list remaining AR for the past 4 to 6 individual months, plus a summary value for all AR older than the oldest individual month (such as over 120 days).
Expected payment per CPT code from any payer including nongovernmental insurer or governmental payer such as Medicaid or Medicare.
Uncollectable charges, not including disallowances and other write-offs.
The process of sending a statement to the patient, or guarantor, to cover the portion of the account that was not paid by the insurer.
Process where the insurer incorporates payment for one service into payment for a second billed service. This usually is seen by combining 2 or more CPT codes into one payment. Bundling edits appear on EOBs as showing certain procedures as “incidental” or “mutually exclusive” and are common with EKGs, x-rays, ultrasound, and moderate sedation codes.
Charge ticket/fee ticket
A form that some ED physicians use to enable the physician to assign CPT codes for the patient visit and for any procedures performed during the visit.
The process of applying accurate CPT and ICD-9 codes to the medical record.
Usually a separate company from the primary billing entity that collects payments on accounts that the billing agent has been unable to collect.
The dollar value that when multiplied by the RVU, gives the allowable Medicare payment amount.
CPT (Current Procedural Terminology)
Codes described in a manual published annually by the American Medical Association that codifies, and describes, all physician services for billing purposes.
Overpayments that have been received for an account.
Input of data into the billing software system. Data entry is required for claim/statement generation, and also for updating any payment activity (payment posting).
Days in AR
Calculation derived by dividing the amount of active AR by the average daily charge (gross days in AR). Net days in AR is similar, but substitutes net AR and net charges.
Amount of AR that cannot be collected secondary to provider-contracted fee schedules with governmental or nongovernmental payers.
A process where the insurer pays for a lesser CPT code than the code submitted by the physician.
Cycle of repetitious demands for payment.
Electronic claims submission
Transmission of billing claims to the insurer via electronic means.
Electronic funds transfer
Electronic transfer of funds from the insurer to the provider's bank account.
Electronic interface with hospital
A communication protocol that allows electronic transmission of patient demographic information from the hospital to the billing agent.
Direct electronic transmission of payment information from the payer's system to the billing agent's software system.
ED registration system
Software applications used by ED registration clerks to enter patient demographic data.
Use of control documents, and procedures, to verify that 100% of billable visits are accounted for.
Standard claim form accepted by most insurers. There are both paper and electronic versions.
Hospital information system (HIS)
Primary software application used by the hospital for patient demographic information and other accounting functions including hospital billing and collections.
International Classification of Diseases, Ninth Edition (ICD-9)
Manual that codifies all diseases and injuries constructed and updated by the World Health Organization.
International Classification of Diseases, Tenth Edition (ICD-10)
10th edition (updated) ICD manual.
Banking arrangement where the deposits are sent directly to a post office box, opened by the bank, and deposited. Copies of payment information and correspondence are then sent to the billing agent.
Sale, by the provider, of AR to a vendor who then owns the AR, and attempts collection.
Percentage of AR greater than 120 days
Calculation derived by dividing the AR greater than 120 days old by the total AR, multiplied by 100.
Process of obtaining provider numbers for practitioners in order to receive payment from certain payers.
RBRVS (resource-based relative value system)
Payment system designed by the CMS that assigns relative weights for provider work, practice expense, and malpractice costs, when calculating the total relative value unit (RVU) for each CPT code.
Process where the insurer reduces provider payment caused by overpayment on a previous account.
Further attempt at collection by another vendor after the collection agency has finished working an account. The provider still owns the AR.
Invoice that is generally sent to the patient or guarantor.
Tax identification number (TIN)
A number that is assigned by the Internal Revenue Service and identifies provider groups. The TIN is listed on all billing claims.
Timely filing limits
Length of time that an insurer allows a claim to be submitted after the date of service.
Time-of-service (TOS) payment
Payment made at the time of the ED visit.
Collection percentage expected to be achieved after all AR is adjudicated. Depending on the internal policy of write-offs of bad debt, ultimate collectability is usually expressed as a percentage 12 to 24 months after the date of service. This is often determined per payer class, and in total.