This is a language you'll need to master. Understanding the complexities of third-party billing can be a challenge especially when it comes to the language of this process.
by Mike Whitmer in Billing and Fees on Tuesday, March 15, 2016
Here are a few terms you should know.
Adjustment to Charges – Services rendered that are ineligible for collection. Adjustment to charges include, but are not limited to, professional courtesy discount, service in kind or barter or the portion of actual charges that exceed usual, customary or reasonable charges.
Ancillary Services – Clinical services that are administered in addition to the manipulation, such as X-Ray, supportive therapy, orthotic devices and nutritional supplements.
Average Charge per Office Visit – The average services rendered. The average charge per office visit is a function of the office fee structure, the number of new patients and ancillary services.
Gross Billings/Total Office Visits
Capitation – A single fee for patient services. Capitation is the opposite of fee for service.
Cash Method Accounting – An accounting method that recognizes income when collected and expenses when paid.
Census - The patient population of the practice. The daily census is the number of patients under treatment, the active census is the number of patients seen within the past 12 months and the total census is the number of active and inactive patient charts.
Catchment Area – The service area of a chiropractic practice. The primary catchment area is the geographical area where 75% of patients either work or live.
Collections – Income collected.
Collection Ratio – The portion of the gross billings eligible for collection.
Collections / (Gross Billings - Adjustments to Charges)
Customary Fee – Fee by a given geographical area for each equally qualified provider. Can be defined by area or Zip Code.
Fixed Rate – A reimbursement rate established by State or Federal Government.
Intensive Office Visits – When the patient is seen more than one time per week.
Length of Stay (LOS) – The function of the inter-relationship of practice development and patient management, which indicates the clinical focus of the practice and accurately gauges patient retention. This takes into account the relationship between acute and rehabilitative care and well care.
(Office Visits - Well care Visits) / New Patients per Month
No-Show – A patient who does not show up for a scheduled appointment. The no-show ratio is calculated as follows:
No-Show Office Appointments / Total Scheduled Office Appointments
Payor Profile – Gross billings allocated according to source of reimbursement, i.e., BlueCross/BlueShield, Medicare, personal injury, workers' compensation, managed care, general group insurance, cash.
Reasonable Fee – The average of the customary fee (usually between 75-90%) determined by the insurance company.
Reschedule Ratio – The percentage of no show patients that reschedule appointed office visits within a week.
Reactivated Patient – An inactive patient that reinstates or reactivates patient service.
Scheduled Benefit – A set fee usually written into a contract limiting the coverage. Usually limited by number of visits or dollar amount.
Service Mix – Gross billings allocated according to patient care, e.g.new patient, chiropractic manipulative therapy (CMT), supportive care, X-Ray and other services.
Services Rendered – The total value of the actual charges billed for patient care activities. Services rendered can also be called production or gross billings.
Usual Fee – The fee you normally charge for a specific service.