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
  

• 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.

• 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.
  

• 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.

• WC

• Workers' Compensation