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Find the meanings of medical billing jargons for a simpler understanding.
The final determination of the issues involving settlement of an insurance claim.
The portion of medical bill that doctor or hospital has agreed not to charge Patient.
Any claims or unpaid insurance that are due past 30 days.
American Medical Association. The largest consortium of doctors in the US. Their publication: American Medical Association is a widely distributed medical journal in the world.
if a claim is submitted by the provider without supporting documents, the insurance company will reduce the code to the closest matching code thereby reducing the payment.
Charges that the patient or the insurance holder is liable to pay.
Fraud: To purposely bill for services that were never given or to bill for a service that has a higher reimbursement than the service produced. Abuse: Payment for items or services that are billed by mistake by providers, but should not be paid for by the insurance plan. This is not the same as fraud.
This act, which was passed in 1996, helps ensure that privacy is maintained in regards to patients’ medical records. It also created a set of standards to which all electronic medical records must adhere.
A Hospital care unit that provides care for patients who are extremely ill or need special care
Analyzes patient charts and assigns the appropriate code. These codes are derived from ICD-9 codes (soon to be ICD-10) and corresponding CPT treatment codes and any related CPT modifiers.
When a healthcare provider is contracted with an insurer to provide service at a discounted price.
A healthcare provider who is not in contract with an insurance carrier. Patients who use an out-of network provider are usually responsible for a greater portion of the charges incurred for the service.
Before the treatment begins, the insurer determines the maximum amount they will pay towards surgery, consultation, or other medical care.
Before the treatment begins, the insurer determines the maximum amount they will pay towards surgery, consultation, or other medical care.
Relative Value Amount. An average amount that Medicare pays a provider for a treatment. This amount is determined by factors such as: the national uniform value of the service and the geographical location.
A nursing home meant for recovery. It provides specialized treatment to patients with long-term illnesses.
A person or an independent entity who manages benefits, claims and administration for a self-insured company or group.
Relative Value Amount. An average amount that Medicare pays a provider for a treatment. This amount is determined by factors such as: the national uniform value of the service and the geographical location.
ICD-9-CM coding cataloging to recognize health care for reasons other than injury or illness.
Insurance claim that is a result of a work related injury or illness.
A difference between the physician fees and the insurance plan coverage for which the patient is not liable. In other words can be called ‘not covered’.