Community Health Center Finance
Data Glossary

Accounts Receivable, Patient - Amounts owed by a patient or a third party insurer to the center.

Admission - The act of placing an individual under treatment or observation in a medical center or hospital.

Aged Trial Balance - A report used to track accounts receivable by patient or third party insurer segregated into categories which represent time periods from the date the claim was billed. A detailed trial balance includes a patient-by-patient breakdown. A summary trial balance is usually by payor category.

Ancillary Care - Tests and procedures ordered by healthcare providers to assist in patient diagnosis or treatment (e.g., radiology, laboratory, pathology, etc.).

Appointment - An arrangement to meet with a provider at a specified time and place for medical purposes.

Assessment - An evaluation or appraisal of a condition utilizing written and/or electronic formats. Assessment is used to determine healthcare needs and can serve as the basis for building a plan of care.

Authorization - Approval from the primary care physician and/or health plan (depending on the plan's specifications) prior to receiving healthcare services, such as visits to specialists.

Automated Information System - Computer hardware, computer software, telecommunications, information technology, personnel, and other resources that collect, record, process, store, communicate, retrieve, and display information. An AIS can include computer software only, computer hardware only, or a combination of the above.

Bad Debt - Accounts Receivable balances after contractual allowances that the center is unable to collect with reasonable effort. When an accounts receivable is deemed "bad" or "uncollectible" it is written off to bad debt through the booking of an Allowance for Doubtful Accounts.

Batched Data Entry - A method of organizing several transactions into a single group for transmitting, processing or printing without further user/operator intervention. This serves to increase the efficiency of the data transmission.

Benefit Package - A defined set of covered service under an insurance or managed care contract. The payment for a benefit package may come through capitation.

Bill - The amount charged for a specific set of services delivered for a specific period of time. It may be adjusted to reflect contractual allowance, insurance coverage, deductibles, payments, or other items.

Billable Visit - A face-to-face contact between a patient and a provider who may bill the patient, an insurer, the state or federal government. A billable visit may be defined by either state law through Medicaid regulation, or by federal law, through Medicare regulation, or by contract with an insurer. In many states, for a given patient, a health center may deliver one and only one billable visit per day (the center may provide many encounters on that day)

Billing History - A chronological record of bills and payments for a patient.

Capitation - A managed care payment system under which providers are paid a per patient monthly fee for a defined set of covered services.

Carved-out Services - Services not included in the benefit package, or services included in the benefit package, but not reimbursable to the health center by contract.

Case Management - A method of managing healthcare provision to members with chronic, ongoing or complex medical conditions. The goal is to coordinate the care so as to both improve continuity and quality of care as well as manage costs appropriately.

Cash Receipt Log - Documentation of money received for a given period.

Charge - The standard amount required for the delivery of service associated with each CPT code, prior to contractual allowance, bad debt, or other adjustment. The charge should approximate or exceed the cost of the service.

Charge Schedule - For all services provided at the center, a list of charges.

Chi-Square - A test statistic that is calculated as the sum of the squares of observed values minus expected values divided by the expected values.

Chi-Square test - A test that uses the chi-square statistic to test the fit between a theoretical frequency distribution and a frequency distribution of observed data, measuring correlation.

Claim - A bill sent to a third party payor.

Contractual Allowance - The difference between the charge by the center to the patient or third party insurer and the agreed upon fee to be paid.

Coinsurance - An arrangement in which the insured pays a percentage of the charges for the health services obtained.

Coordination of Benefits (COB) - In the event that the insured has duplicate or overlapping coverage, the center or primary insurer would coordinate reimbursement from all payors.

Co-Payment - A cost sharing arrangement in which the insured pays a specified flat amount for a specific health service and the health plan is responsible for the balance.

Cost Center - Any department or other unit of the organization or any portion of such a unit for which management chooses to accumulate cost information. Cost centers usually parallel an organization's structure.

CPT (current procedural terminology) - A unique five-digit codes that defines a medical service delivered, as defined by the American Medical Association.

Credit - An amount allocated to a patient or payor that reduces the receivable due to the center.

Database - A large collection of data organized for rapid search and retrieval or a program that manages data, and can be used to store, retrieve, and sort information.

Data Integrity - The process of ensuring the data is accurate, consistent, and meaningful.

Data Warehouse - Multiple databases used to store sharable read?only data that is updated from an operational database-of-record. Allows users to tap an organization's data store to track and respond to business trends and facilitate forecasting and planning efforts.

Date of Service - The date a patient receives care.

Days in Accounts Receivable - Total accounts receivable balance divided by average daily net revenue.

Deductible - That portion of a subscriber's (or member's) healthcare expenses that must be paid out of pocket before any insurance coverage applies. Commonly $100 to $300 in insurance plans and Preferred Provider Organizations, but uncommon in HMOs. May apply only to the out-of-network portion of a point-of-service plan.

Denial - Notification from an insurer that a claim for payment (or request for pre-authorization) is not approved, due to documentation deficiencies, ineligibility of the member, lack of medical necessity or other reason.

Department - An organizational unit of the center or of the medical staff.

Dependent - A person who is eligible for care because of his or her relationship to a subscriber.

Diagnosis - A term, represented by ICD-9 code, used to identify a disease or problem from which an individual patient suffers.

Discharge - The end of hospitalization by order of the physician, against medical advice, or by death.

Double Entry Accounting - A system of recording transactions in a way that maintains the equality of the accounting equation. In double-entry accounting, every transaction has two journal entries: a debit and a credit. Debits must always equal credits.

Electronic Data Interchange - Exchange of information between computers using highly standardized electronic versions of common business documents.

Electronic Mail (e-mail) - Messages passed from one computer user to another, often through computer networks and/or via modems over telephone lines.

Eligibility - Standards by which an individual qualifies for health coverage.

Encounter - Face-to-face contact between a patient and a provider of service. The provider has primary responsibility for assessing and treating the patient at a given contact, exercising independent judgment. A patient may have multiple encounters on any given day.

Excess Program Income (EPI) - These dollars represent the amount of income earned from fees for services, premiums and third-party reimbursements including health plans and/or Medicare/Medicaid reimbursements above that needed for actual costs of operation and above the amount projected in the center's grant application.

Explanation of benefits - A statement explaining how and why a claim was paid or not paid.

Equipment - Items used to facilitate treatment, rehabilitation, or diagnosis. Generally, can withstand repeated use. Medical equipment is primarily and customarily used to serve a medical purpose and is usually not useful to a person in the absence of illness or injury.

Federally Qualified Health Center (FQHC) - Health centers that are receiving section 300 funding and are eligible for cost-based reimbursement from Medicare and Medicaid; or meet the standards for funding (look-alikes).

Fee-For-Service - A traditional form of reimbursement in a healthcare where payment is based on services rendered to the patient.

Fee Schedule - A listing of the maximum fee that an insurer or health plan will pay for a service based on the CPT code.

Financial Status Report (FSR) - This is a major regulatory requirement for Federal grants, acting as the organization's certified statement of the Federal share of the grant, the unobligated balance of funds (UOB), and the excess program income (EPI). The FSR is an official claim of expenditures for the federally funded project submitted by the grantee to PHS. A separate and independent FSR must be submitted for each grant within 90 days of the end of the pertinent budget period.

Frequency Count - A count of the incidence or occurrence of a particular value.

Full Time Equivalent (FTE) - The equivalent of one full time employee, as defined by hours worked.

General Ledger - A book or file of final entry summarizing all of a company's financial transactions, through offsetting debit and credit accounts.

Global Fee - The contracted payment amount for a defined subset of services, such as obstetrical services that encompass prenatal, delivery and post-natal care.

Guarantor - A person or entity that agrees to be responsible for the payment of another's charges for medical services.

Health Center - An organization providing primary care, specialty care, ancillary care services, and other services. Typically, health centers are owned and operated by community-based organizations.

Histogram - A representation of a frequency distribution by means of rectangles whose widths represent class intervals and whose areas are proportional to the, corresponding frequencies.

Immunization - Protection of susceptible individuals from communicable diseases by administration of a living modified agent, a suspension of killed organisms, or an inactivated toxin.

Incurred But Not Reported (IBNR) - Services that have been provided but not reported to the insurer by some specific date. The estimated value of these claims is a component of an insurance company's current liabilities.

Insurance - System where individuals prepay amounts to a company which assumes responsibility for the costs of healthcare rendered.

Integrated Services Network (ISN) - Loose term referring to organizations which integrate multiple components of the care continuum.

Intervention - A generic term used in healthcare to describe a program or policy designed to have an impact on an illness or disease.

Joint Commission on Accreditation of Healthcare Organizations (JCAHO) - An independent, not-for-profit organization, the Joint Commission is the nation's predominant standards-setting and accrediting body in health care. JCAHO's mission is to continuously improve the safety and quality of care provided to the public through the provision of health care accreditation and related services that support performance improvement in health care organizations. Accreditation by the Joint Commission is recognized nationwide as a symbol of quality that indicates that an organization meets certain performance standards. To earn and maintain accreditation, an organization must undergo an on-site survey by a Joint Commission survey team at least every three years. The Joint Commission's standards address the organization's level of performance in key functional areas, such as patient rights, and the standards focus not simply on what the organization
has, but what it actually does. Standards set forth performance expectations
for activities that affect the quality of patient care -- if an organization does the right things and does them well, there is a strong likelihood that its patients will experience good outcomes. The Joint Commission develops its standards in consultation with health care experts, providers, measurement experts, purchasers and consumers

Journal Entry - A recording of a transaction where debits equal credits; usually includes a date and an explanation of the transaction.

Laboratory - A facility equipped to carry out investigative and diagnostic pathology procedures.

Length of Stay - The number of occupied bed days accumulated from the date of admission to the date of discharge.

Managed Care Plan - An organization that is responsible for the healthcare costs of an enrolled population.

Mean - Average value calculated by taking the sum of all values and dividing by the total number of values. Commonly referred to as the "average."

Median - The middle value of a distribution.

Medical Record - Paper or electronic versions of patient chart detailing diagnosis and services provided.

Net Worth - Amount by which assets exceed liabilities.

Notice of Grant Award (NGA) - Official notification from DHHS of the grant funding level.

On-line Data Entry - Process of entering data in real-time, directly into a computerized form.

Patient - A person receiving medical or dental care or treatment.

Patient Demographics - Information such as age, race income, sex, education. occupation, etc. that is used to characterize a patient population.

Payment Management System (PMS) - System within DHHS which monitors grants authorized and dispersed.

Payor Mix - The distribution of services, charges, or revenue among payor categories such as Medicare, Medicaid, managed care, commercial insurance, and self?pay. The payor mix is often used to identify changing demographic trends in an organizations patient base.

Physical Exam - Systematic and thorough inspection of the patient for physical signs of disease or abnormality.

Posting - To add transactions in the chronological order in which they were generated, into a general ledger.

Precertification - Process where a patient's proposed medical treatment is reviewed in advance to determine need and appropriateness.

Primary Care Provider - A designation given to a provider that the patient selects to direct and manage their healthcare needs.

Primary Care Effectiveness Review (PCER) - Primary Care Effectiveness Review is part of Public Health Service (PHS) responsibility for administering Section 330 grants and is conducted when warranted by PHS, usually at the end of a project period. It may be done anytime a health center is having problems. It permits PHS to better understand your overall operations. It identifies areas of strength and weakness; monitors compliance with Bureau of Primary Health Care (BPHC) regulations, and develops joint plans for future technical assistance. The PCER is a critical step in the overall process which leads to re-evaluation as a BPHC grantee. Responses to findings from visits are required to be included in the competing grant application. The team consists of Finance, Clinical, Governance, and Administration.

Procedure - A single service or set of services provided to a patient.

Productivity - A term used to reflect the volume of activity of a provider, group of providers or organization for a defined period. Productivity may be defined by encounters, billable visits, procedures, or relative value units.

Protocol - Precise and detailed plans for the study of a medical or biomedical problem and/or plans for a regimen of therapy.

Provider - A licensed healthcare professional or entity, or group of licensed healthcare professionals that provide healthcare services to patients. Examples can include but are not limited to physicians, dentists, HIV Case Managers, social workers, mid-levels, and podiatrists.

Random Sample - A group selected randomly, solely by chance.

Referral - Practice of sending a patient to another program or practitioner for services or advice that the referring source is not prepared or qualified to provide.

Registration - The process of collecting the necessary demographic information about a patient upon initial entry or recertification with the center.

Resource-Based Relative Value Scale (RBRVS) - A relative value scale developed for the Health. Care Financing Administration (HCFA) for use in the Medicare program. RBRVS assigns relative value to each CPT code for services on the basis of the resources related, to the procedure rather than simply on the basis of historical trends. The practical effect has been to lower reimbursement for procedural services (e.g., cardiac surgery) and to raise reimbursement for cognitive services (e.g., office visits).

Relative Value Units (RVU) - The unit of measure for the Medicare RBRVS (see above). An RVU is made up of three parts: work relative values (RVUw), practice expense relative values (RVUp), and malpractice relative values (RVUm). The sum of these values is multiplied by a conversion factor and a geographic adjustment factor to determine a reimbursement rate.

Report-Writing Tool - A type of software product or function of a software product used for developing reports from a database.

Revenue (Gross) - The amount charged for services delivered to the patient.

Revenue (Net) - The gross revenue less contractual allowance, sliding fee discounts, and other adjustments.

Scatter Plot - A graphing of data points in which each point represents the simultaneous value of two variables. A scatterplot usually has the independent or explanatory variable on the x-axis and the dependent or outcome variable on the y-axis. Scatter plots are often used to show relationships between levels of two variables.

Sliding Fee Discount - A reduction of the charge based on the organizations approved policy reducing the amount owed based on income and family size.

Sliding Fee Scale - The schedule detailing the sliding fee discount for each service provided by category. Each individual who qualifies for a sliding fee discount during the registration process is assigned a category based on income and family size.

SOAP (Subjective, Objective, Assessment, Plan) - The purpose of a SOAP chart is to document the patient's current condition, the therapist's findings and treatments, changes resulting from the treatment, guidelines for future treatments, and the patient's homework. SOAP charting is a popular format for documenting treatment sessions in the healthcare field, routinely used by doctors, physical therapists, nurses, etc.

Specialist - Physician, dentist, or other healthcare professional, usually with special advanced education and training.

Standard Deviation - A statistic that shows the dispersion of scores in a distribution. The more widely the scores are spread out, the greater the standard deviation.

Structured Query Language - An industry-standard language for creating, updating and querying relational database management systems.

Symptom - Any abnormal change in appearance, sensation, or function experienced by a patient that indicates a disease process.

Therapy - The treatment of disease through the application of therapeutics.

Third Party Payor - Any organization, public or private, that pays or insures health or medical expenses on behalf of beneficiaries or recipients.

Transaction - Event or condition recognized by an entry in the books of account.

Uniform Data System - An integrated reporting system used by grantees of specific primary care systems development programs to report healthcare clinical and performance data to the Bureau of Primary Health Care.

Unobligated Balance of Federal Funds (IJOB) - This amount represents the unspent amount of Federal grant funds.

Utilization - Use of services and supplies: Utilization is commonly expressed in terms of patterns or rates of use of a single service or type of service such as hospital care, physician visits, and prescription drugs. Measurement of utilization of all medical services in combination is usually done in terms of dollar expenditures. Utilization is expressed in rates per unit of population at risk for a given period.

Visit - A visit, without the term billable, may be synonymous with an encounter.

Write-Off Allowance Account - Account holding receivables that are deemed uncollectible.


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