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Med. Billing Terms
Medical Insurance Terms-Winter 1-17
| Question | Answer |
|---|---|
| ABN-Advance Beneficiary Notice | Form used to notify patients in advance that a service may not be covered and the patient may be responsible |
| Actual Charge | The amount a physician or supplier actually bills a patient for a particular service or supply |
| Appeal | complaint beneficiaries make if they disagree with any decision about their health care services |
| Appellant | an individual who appeals a claim decision. |
| Approved Amount | The amount an insurance carrier deems reasonable for the billed charges. |
| Assigned Claims | a claim form that directs payment to the provider/supplier. |
| Assignment of Benefits | Authorization for the insurance company to send insurance payments directly to the health care provider, also, an agreement with Medicare that the provider will accept the remittance as full payment. |
| Audit | process to ensure that Medicare reimburses providers based only on cost associated with patient care |
| Beneficiary | a person eligible to receive insurance benefits |
| Claim | request for payment for Medicare benefits or services rendered by a provider. |
| CMS | Ceters for Medicare and Medicaid Service-administers and oversees the medicare program and a portion of the state Medicaid program |
| COB-Coordination Of Benefits | a program for determining which health insurer pays for services first when a beneficiary is covered by more than one health care plan. |
| Co-Insurance | The medicare co-pay paid by the patient for services. it is sometimes referrred to as a co-payment |
| CPT-Current Procedureal Terminology | system of uniformed medical procedure codes to identify specific health care services |
| Deductible | the amount that must be paid by a beneficiary before an insurere begins to pay for medical services |
| Diagnostic-Related Groups (DRG) | classification of diangoses used to determine hospital payment for medicare inpatients |
| ESR-End Stage Renal Disease | Kidney failure that is severe enough to require lifetime dialysis or kidney transplant |
| Utilization Review | review of individual cases by a committee to ensure services are medically necessary and to study how providers use medical resources |
Created by:
d.holifield
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