EHR Billing and Revenue Cycle Flashcards

What is evaluation and management (E/M) coding in EHR outpatient billing?

Answer: A set of CPT codes used to bill for physician services based on the complexity of the medical decision-making or time

E/M codes are a series of CPT codes (99202-99215 for office visits) used to bill for physician or provider cognitive services based on medical decision-making complexity or total time.

What is a fee schedule in the context of EHR revenue cycle management?

Answer: A list of the maximum amounts a provider will charge for each service, often negotiated with payers

A fee schedule is a list of charges a healthcare provider has established for each service, which forms the basis for claims submitted to payers who then reimburse at contracted rates.

What is the function of a clearinghouse in EHR electronic billing?

Answer: An intermediary that receives claims from providers, checks them for errors, and routes them to the correct payer

A clearinghouse is an electronic intermediary that validates and reformats claims from provider EHR systems before routing them to the appropriate insurance payer for adjudication.

What is accounts receivable (AR) days in healthcare revenue cycle analysis?

Answer: The average number of days it takes to collect payment after a service is rendered

AR days measures the average time from service delivery to payment collection, with lower AR days indicating more efficient revenue cycle performance.

What is balance billing in healthcare, and why is it a compliance concern?

Answer: Charging patients the difference between the provider's fee and what insurance pays, which may be prohibited for in-network providers

Balance billing is the practice of billing patients for the difference between a provider's charge and the insurance payment, which is prohibited for in-network providers under most contracts.

What is the No Surprises Act's impact on EHR billing workflows for US providers?

Answer: It requires good faith cost estimates to be provided to patients before scheduled services and prohibits unexpected out-of-network bills

The No Surprises Act (effective 2022) requires US providers to give patients good faith cost estimates before scheduled care and prohibits surprise bills from out-of-network providers at in-network facilities.