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1. Claim Denial: When an insurance company rejects a healthcare claim due to errors, missing information, or lack of coverage.
2. Accounts Receivable (AR): The total amount of money owed to a healthcare organization by patients, insurance companies, or other payers for services rendered.
3. CPT Codes: Current Procedural Terminology codes that identify specific medical procedures or services provided to patients for billing and reimbursement purposes.
4. EOB (Explanation of Benefits): A statement from an insurance company that explains how a claim was processed, including details about payments, denials, and patient responsibility.
5. ICD-10 Codes: International Classification of Diseases, 10th Revision codes used to classify and code medical diagnoses, symptoms, and procedures.
6. Revenue Cycle Management (RCM): The process of managing the financial aspects of healthcare services, including billing, claims processing, and revenue optimization.
7. Remittance Advice (RA): A document sent by insurance companies to providers, detailing the payments made for submitted claims and any adjustments or denials.
8. Charge Capture: The process of accurately capturing and documenting healthcare services provided to patients for billing and reimbursement purposes.
9. Clean Claim: A claim that is accurately completed, contains all necessary information, and meets the requirements for timely processing and reimbursement by insurance companies.
10. Health Information Management (HIM): The practice of organizing, managing, and ensuring the accuracy and security of patient health information and medical records within healthcare organizations.
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