An amount (positive or negative) entered in a billing program to change an account balance.
Fee for services other than room and board provided during a patient's hospitalization, such as anesthesia, pharmacy, supplies, and therapies.
The clinician primarily responsible for the care of the patient from the hospital admission through discharge or transfer.
A billing system feature that stores all charges for particular services; when a service is provided, the system automatically bills all of its component charges.
Release of a patient from a facility, including those who have died and those who are transferred to another facility.
DNFB - discharged/not final bill
A hospital list containing the accounts of patients who have been discharged but whose claims have not yet been transmitted to payers, used by hospitals to measure the timeliness of their billing process.
A listing of the services, procedures, and revenue departments for collecting charges for a patient's visit; also called a charge ticket or superbill.
EOB - explanation of benefits
A document from a payer to a patient or a provider that shows how the amount of a benefit was determined.
Surgical procedures which, due to their invasive nature and the need for a twenty-four-hour recovery time, Medicare has designated will only be paid for if performed on an inpatient basis.
Payment criterion of payers that requires medical treatments to be appropriate and provided in accordance with generally accepted standards of medical practice.
Prior authorization from a payer that must be received before elective hospital-based or outpatient surgeries are covered; also preauthorization or authorization.
The work of physicians—such as surgeons, anesthesiologists, and patients' private doctors—that is billed to patients by the physician rather than by the facility.
QIO - quality improvement organization
An organization hired by CMS to determine the medical necessity, appropriateness, and quality of patients' treatments; formerly Peer Review Organization (PRO).
RA - remittance advise
The document sent by a payer to a provider that itemizes the patients, claims, and explanations for payment decisions included in the attached payment.
The total of the costs of all supplies that are customarily used to provide the service; items included in the routine charge should not be billed separately.
A patient's balance that the billing department has determined cannot be collected from the debtor and is written off.