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Across 5. Coverage rules, at a fiscal intermediary or carrier level, that provide information on what diagnoses justify the medical necessity of a test (3 words) (3 Words) 6. A claim that has all the billing and coding information correct and can be paid by the payer the first time it is submitted. (2 words) (2 Words) 8. A voluntary medical insurance program that helps pay for physicians' services, medical services, and supplies not covered by Medicare Part A. (3 words) (3 Words) 9. The practice of counting the days, generally in thirty-day increments, from the time a bill was sent to the payer to the current day. (3 words) (3 Words) 12. A report that includes all patients who have been discharged from the facility but for whom, for one reason or another, the billing process is not complete. (4 words) (4 Words) 16. The practice of assigning diagnostic or procedural codes that represent higher payment rates than the codes that actually reflect the services provided to patients. 17. The difference between what is charged by the healthcare provider and what is paid by the managed care company or other payer. (2 words) (2 Words) 18. The ratio of charges (revenue) for goods and services to the actual reimbursement (cash) based on a percentage of those charges. (3 words) (3 Words) 19. The actual amount of money collected that is owed for goods or services provided. 21. The average relative weight of all cases treated at a given facility or by a given physician, which reflects the resource intensity or clinical severity of a specific group in relation to the other groups in the classification system; calculated by dividing the sum of the weights of diagnosis-related groups for patients discharged during a given period divided by the total number of patients discharged. (3 words) (3 Words) 22. A person assigned solely to the function of coding. 23. The circumstance when a bill has been accepted, but payment has been denied for any of several reasons (for example, sending the bill to the wrong insurance company, patient not having current coverage, inaccurate coding, or lack of medical necessity.) Days in Accounts Receivable / The ending accounts receivable balance divided by an average days revenues. (4 words) 25. The amount of money owed a healthcare facility when claims are pending. (4 words) (4 Words) 26. Similar to contractual allowance. (3 words) (3 Words) 27. The span of time during which a bill is suspended in the billing system awaiting late charges, diagnosis and/or procedure codes, insurance verification, or other required information. (4 words) (4 Words) 29. A process whose ultimate goal is improved financial management, including an accelerated cash flow and lowered accounts receivable. (3 words) (3 Words) 30. The process of how patient financial and health information moves into, through, and out of the healthcare facility, culminating with the facility receiving reimbursement for services provided. (2 words) (2 Words) 31. The processes of preregistration, prebooking, scheduling, and registration activities that collect patient demographic and insurance information, perform verification of patient insurance, and determine medical necessity. (3 words) (3 Words) 32. An established time between the date of service and the date the claim is sent to the payer. (2 words) (2 Words)

Down 1. The percentage of revenue collected as cash over a given period of time, or the ratio of cash to revenue. (2 words) (2 Words) 2. A federal program that covers the costs associated with inpatient hospitalization as well as other healthcare services provided to Medicare beneficiaries. (3 words) (3 Words) 3. The equivalent of LCD's at the national level. (3 words) (3 Words) 4. A condition that must be satisfied before a computer system can accept data; a software check. 7. An organization that contracts with the Centers for Medicare and Medicaid Services to serve as the financial agent between providers and the federal government in the local administration of Medicare Part B claims. (2 words) (2 Words) 10. Records of the payments owed to the organization by outside entities such as third-party payers and patients. (2 words) (2 Words) 11. A balance on an account that is to be refunded to an insurer or to the patient. (2 words) (2 Words) 13. The office through which the federal government established compliance plans for the healthcare industry. (5 words) (5 Words) 14. A charge that has not been posted within the healthcare facility's established bill hold time it is submitted. (2 words) (2 Words) 15. Applicable services that are cut out of the contract and paid at a different rate. (2 words) (2 Words) 20. Processes that deal with the results of the claims submission process, including payment posting, denial management, and collection. (3 words) (3 Words) 24. Compensation or repayment for healthcare services. 28. The receivables of an organization that are uncollectible. (2 words) (2 Words)