Chapter 4

accept assignment

Answer explanation

provider accepts as payment in full whatever is paid on the claim by the payer (except for any copayment and/or coinsurance amounts).

accounts receivable

Answer explanation

the amount owed to a business for services or goods provided.

accounts receivable aging report

Answer explanation

shows the status (by date) of outstanding claims from each payer, as well as payments due from patients.

accounts receivable management

Answer explanation

assists providers in the collection of appropriate reimbursement for services rendered; includes functions such as insurance verification/eligibility and preauthorization of services.

allowed charge

Answer explanation

the maximum amount the payer will reimburse for each procedure or service, according to the patient's policy.

ANSI ASC X12

Answer explanation

an electronic format standard that uses a variable-length file format to process transactions for institutional, professional, dental, and drug claims.

appeal

Answer explanation

documented as a letter, signed by the provider, explaining why a claim should be reconsidered for payment.

assignment of benefits

Answer explanation

the provider receives reimbursement directly from the payer.

bad debt

Answer explanation

accounts receivable that cannot be collected by the provider or a collection agency.

beneficiary

Answer explanation

the person eligible to receive health care benefits.