Glossary of Terms

Glossary of Terms

   Glossary of Terms   

  • 835 File

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

  1. Allowed Fee

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

  1. ALWD

    1. 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

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

  • Bill Date

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

  • BWC

    • Bureau of Workers' Compensation (or WC)

  • CM  

  • 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

  • EDI:

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

  • Modify Icon  

  1. The Pen and Paper Modify Icon appears throughout the System and is used to modify previous entries.
  2. 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 our 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 and how much the Patient is responsible for.

    • 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: 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.

  • Payment

    • A Payment is the application of the money against an open balance, and can be in a different Reference Batch and/or Reporting Period than the Receipt

  • 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.

  1.  Post Date 

    • The Post Date is determined by the Date set in the Reference Batch.

  • 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 the date entered on the Receipt or the date that auto-populates on the ERA Receipt.

  • This is the date that the Payment was received.

  • RTCS 

RVU (Relative Value Unit)  

  • 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 champions that will have all permissions and security rights in order to properly manage the database 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


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