Glossary of Terms   

835 File

• Also referred to as: Electronic Remittance Advice (ERA)
• The 835 is the electronic transaction that provides Claim Payment information which is used to auto-post Claim Payments.

Allowed Fee

• This is pulled from the uploaded Allowed Fee Schedule and indicates the Payer's expected contractual amount.

ALWD

• This is the posted allowed amount that was provided on the EOB/ERA from the Payer for an Encounter.

AM

• Account Manager

ANSI

• National format standard for transmitting electronic information.

Applied Date

• This is the date the Applied button was used on the ERA.
• This date may be different than the Post Date since the Post Date is driven by the Date used in the Reference Batch.

Beta Feature

• The early use of a new feature that allows Users the chance to take advantage of the functionality and provide feedback before the feature's general release.

Bill Date

• The most recent date that the claim was billed to the Responsible Party.

BWC

• Bureau of Workers' Compensation (or WC)

CM

• Crossover Mapping on an ERA.
• Contract Management: Category option on the CARC Denial Rules

Days in A/R

• Total A/R divided by the average billed amount per day over a given time period.
• It is the number of days the average claim will remain outstanding before payment is made.

DB

• Database

Denials

• Denials are received from a Payer after adjudication as an explanation of non-payment.

Disbursements

• On the Receipt, the Disbursed field can be used to flag items that do not belong in the System, such as, Old System Payments.

DOS

• Date of Service

Dunning

• Dunning is the process of businesses communicating with customers in an effort to collect money owed for goods and/or services provided.

Dunning Level

• Dunning Levels are a measure of where a patient's balance is in the effort to collect the balance which drives the collection activities. 

• When a paper or e-statement is delivered, the Dunning Level increases by 1.
• When an acceptable payment is made, the Dunning Level decreases by 1 (or back to 0 regardless of the Level, depending on system settings). 

EDI

• Electronic Data Interchange.
• The method in which Claims, Eligibility, and Remittances are processed electronically.

Modify Icon  

• The Pen and Paper Modify Icon appears throughout the System and is used to modify previous entries.
• This icon will be referred to as the Modify icon in the documentation.

EFT

• Electronic Funds Transfer
• The Payer deposits the Payment directly into the bank instead of sending a paper check.
• The Practice is responsible for completing the setup with each Payer.
• We do not manage the setup for EFTs.

Encounter

• A Charge that can contain multiple Dates of Service.
• The System is an Encounter-based accounting system, which means it looks to the charge to drive a majority of the reporting.

EOB

• Explanation of Benefits: This is a statement received from the Insurance Company that summarizes the cost of health care services that were received.
• Shows how much the Provider is charging the Insurance Company, how much the Insurance is paying, and the Patient's responsibility.
• It is not a bill.

ERA

• Electronic Remittance Advice
• An electronic Explanation of Benefits (this is not the same as an EFT).
• Some payers require enrollment to receive electronic EOBs.
• ERAs are used to auto apply transactions based on the file that the Payer provides us with.

Escrow

• Money that has been entered into the system on a Receipt but has not yet been applied to a service/Encounter.
• It is used as a temporary holding place until the Payment is posted in full.

Etactics

• Clearinghouse
• Used to send, receive and process electronic Claims, Eligibility and Remittances. Enrollments for Claims, Eligibility and Remittances are handled by Etactics.

Etactics Output Solutions

• Etactics Output Solutions is a Partner that is used for sending Statements and Invoices.

Fee Schedules

• Charge Each DB should have one default charge fee schedule. These are the fees per CPT we send on the encounter or charge
• Allowed: It is recommended each DB has at least the Medicare allowed fee schedule - this can be used to be sure you are being paid according to the contract you have with the payer

Go Cuts

• Keyboard shortcuts to the various areas of the System.

Go-Live

• Date that the Practice will begin billing Claims and partner Invoicing for the Practice’s services will begin.
  

Guarantor vs Patient

• The Guarantor is the person who is responsible for Payment and is the person who will receive the Statement.

• The Patient is the person who is being seen by the Provider or getting treatment.

• The Guarantor may be the same as the Patient or can be another person.

• The Guarantor has an ID that can be different than the Patient ID even if the Patient is the Guarantor.

• Example: Patient and Guarantor are the same person.

• Emily Test's Patient ID is 13299.

• Emily is her own Guarantor.

• Her Guarantor ID is 12226.

Guarantor vs Policy Holder

HCFA

• Paper Claim Form

Show Me How

• Help documents, walk throughs, and videos embedded in the System.

IM

• Implementation Manager (Trainer)

Implementation

• The process in which a Partner or a Practice is involved in during the initial setup.

Libraries

• Used as the basic building block for Claims, Statements, and Calendar setup.

Loaded Date

• The date the ERA was loaded into the PM System.
• This date may be different from the Received Date.

OS

• Output Solutions (Statement Department)

Parse

• To convert the imported data file into System mapped fields

Payer

• Insurance Company, Attorney, Collection Agency or Third Party responsible for processing and paying Claims.

Payer ID

• Most Insurance companies are able to process Claims, Eligibility and Remittances electronically.
• The Payers have a correlating Payer ID which serves as an electronic address.

PM

• Practice Management

Pop-up

• A smaller screen within a larger screen.
• These may be validation errors or warnings or a screen for entering additional information.

POPS (PatientOps)

• Patient Online Payments & Scheduling (Premium add-on).
• Online Payments are live and Scheduling is coming soon.

POS

• (Place of Service) Place where the service is performed.
• Selecting Yes for the POS Payment field allows you to track Payments that were made in the office.
• When adding the Receipt from the Calendar, it automatically defaults to Yes, but has to be chosen when adding a Patient Payment from the other places in the System.
• Report on POS Payments using these reports Custom Receipt Query, Payments and Adjustments Report, and Receipt Management Report.

Post Date

• The Post Date is determined by the Date set in the Reference Batch.
• It can be used to manipulate Post Dates at month end.

Receipt

• The Receipt holds the details of the money received, who the Payer is, how much was deposited in the bank.

Received Date

• The Received Date is entered on the Receipt or the date that auto-populates on the ERA Receipt.
• This is the date that the Payment was received.

Responsibility Date

• The date that the party became responsible for the Balance.

• Self-Pay: The date the Charge was posted.
• Not Self-Pay: The date the Balance was transferred to the Patient.

Rejection

• Rejections are received from the Clearinghouse or Payer before adjudication as an explanation that the Claim cannot be adjudicated as it was sent.

RTCS

• Real-Time Claim Status

• Electronic Method of getting an immediate Claim Status update from the Payer.

RVU (Relative Value Unit)

• RVUs define the value of a service or procedure relative to all services and procedures.

Site Admin

• Each practice should have 1-2 PM Super-Users that will have all permissions and security rights in order to manage the database properly and its users.

Statement Department

• Etactics Output Solutions is a Partner that is used for sending Statements and Invoices.

TPA

• A Third Party Administrator is the entity responsible for the Processing and Payment of Claims for an Employer.

Visit

• A Visit represents a distinct Date of Service in Reporting.

• A Visit can contain multiple Encounters with the same DOS.

• Example 1: A Patient has 4 Encounters on the same Date of Service. This is calculated as 1 Visit.

• An Encounter can contain multiple Visits with different Dates of Service.

• Example 2: A Patient has 1 Encounter with 4 Dates of Service. Each Date of Service is counted as 1 Visit, which will be a total of 4 Visits.

WC

• Workers' Compensation