MOF Glossary

 the electronic system that AHCSPC uses to send prescriptions to the pharmacies.

Red Carpet Registration is essentially the rapid enrollment of patients. Typically, this involves someone from our enrollment team to go to the physician’s office to offer in-person training to the staff and physician. Not only that, but they will begin to enroll patients as they come into the physician practices. 

When patients are registered into the MOF system from their clinic's EHR.

Diseases that affect the lungs and other parts of the respiratory system. These disorders can be caused by infections, smoking tobacco, and other negative environmental exposures. Respiratory system diseases are commonly referred to by the ICD-10 codes J00-J99, except for smoking-related illnesses, which are usually referred to by Z-codes, and certain other conditions.

Revenue Cycle Management (RCM) is the process healthcare organizations use to track and manage the financial aspects of patient care — from the moment a patient schedules an appointment to the time the provider receives full payment for services rendered.

RCM ensures that healthcare providers get paid accurately and on time by coordinating clinical, administrative, and financial functions.

• Patient Registration & Eligibility Verification

  • Collect patient demographics and insurance information.

  • Verify insurance coverage and benefits to prevent denials later.

• Service Documentation & Charge Capture

  • Providers document the visit, procedures, and diagnoses.

  • Charges are generated based on this documentation.

• Medical Coding

  • Diagnoses and procedures are translated into standardized codes (e.g., ICD-10, CPT, HCPCS) for billing.

• Claims Submission

  • Clean claims are sent to the appropriate insurance payer electronically.

• Claims Adjudication

  • The insurance company reviews the claim, applies benefits, and determines payment or denial.

• Payment Posting

  • Payments from insurance and patients are recorded in the billing system.

  • Any underpayments or denials are flagged for review.

• Denial Management & Appeals

  • Rejected or denied claims are corrected and resubmitted.

  • Appeals are made if necessary to recover revenue.

• Patient Billing & Collections

  • Patients are billed for their share (copays, coinsurance, deductibles).

  • Follow-ups ensure collection of outstanding balances.

• Reporting & Analytics

  • Regular reports track key metrics like days in A/R (Accounts Receivable), denial rates, and collection rates to identify areas for improvement.

Remote patient monitoring. The primary service offered by MOF, RPM uses digital technology to observe and assist patients outside of traditional clinic settings and allows them to take a more active and engaged role in their own healthcare.

Remote therapeutic monitoring. This is a service offered by MOF to AHCSPC patients aimed at patients with musculoskeletal and respiratory system conditions. It uses diagnosis-specific health surveys that patients can complete via the app. Care managers track patient responses to these surveys so they can quickly address any problems that may arise.