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Medical Billing fall

Terms for Medical Billing

QuestionAnswer
Assignment of Billing Authorization for the insurance company to send insurance payments directly to the health care provider , also an agreement w medicare that the provider will accept the remittance as full payment
Beneficiary A person eligible to receive insurance benefits
Birthday Rule A method use to determine the primary insurance carrier when children are covered under both parent's insurance, th parent who birthday falls first, becomes the primary carrier
Capitation A health care insurance payment made to a provider based on a fixed amount per enrollee assigned to that provider; regardless of serviced provided
Carrier Insurance company that provides that policy and benefits
CHAMPVA Service benefit program with no preminums for select family members of specific veterans, spouses and dependents for military personnell with perm, toal service related disability or spouses and dependents of military personnel who died from a service-rel
Coinsurance fixed percentage of covered charges contractually assumed by the insured party
copayment small fixed fee that is collected at the time ofthe visit
deductible fixed dollar amount that must be paid, met once a benefit year, befoe the insurance company beginsto cover medical expenses
dependent a person covered under the primary insured's policy
exclusion conditions or circumstances that are not covered under the insurance plan
EOB (explanation of benefits) a claim summary indicating what services were covered, what was not covered, and why, also referred to as a remittance advice
Fee for Service A payment made to the health care provider for each service rendered
Fee Schedule a list of a physician' customary charges, may incorporate insurne plan specific discounts
Health Maintenance Organization (HMO) an association that provides all care to the insured person for a fixed fee, usually paid for the by insured or employer through a monthly premium, a copayment may or may not be required
Indemnity Plan through which the insured person selects his or her own health care providers; an established amount or percentage of care cost is paid b the insurance plan on a fee service basis, deductibles n limits.
Created by: d.holifield
 

 



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