Once again these are not unfamilair terms as they are also used as prefixes in other non-medical words. It means contracted providers who accept capitation will receive a bulk payment (like a salary) on a periodic basis irrespective of the number of claims received by the insurance company from the same provider for a particular period. This is not typically allowed per the provider's contract with the insurance company, but may be in special circumstances. A - E F - K S - Z MAC - Medicare Administrative Contractor. NOS: Not Otherwise Specified. As we register these roots in our memory centers slowly we make meanings and links. Title I of the act protects workers’ health insurance when they change or lose jobs. Supplemental Insurance: An insurance policy which covers gaps in payment by any of the patient's other insurance policies, such as Aflac or Medigap.

Be it a diagnosis, an examination or an investigation the results and reports are awash with strange looking words that bring on anxiety and a quick scramble to a Medical Dictionary. The AMA is the largest association of doctors in the United States found in 1847. A lot of Latin roots take the modifier -al : Vascular - pertaining to the blood vessel. It is medical billing terminology, used to describe the amount a patient is responsible for paying that is not covered by the insurance plan. Sometimes called a “cafeteria plan,” this plan provides individuals who sign up the option of choosing between an HMO, PPO, or POS coverage (See “Health Maintenance Organization (HMO),” “Preferred Provider Organization (PPO),” and “Point of Service (POS) Plan”). Explanation of Benefits (EOB): The information an insurance company sends a patient after the patient has received medical treatment. If you have a Medicare supplement policy, it may or may not cover the 15 percent "Medicare excess" charge.
Non covered charge is one of the denials used to describe the procedure not covered by the patient’s health insurance plan. Enrollee means an individual covered by health insurance.

We also recommend the ebook The Basics of Medical Billing for getting a good grasp of the industry. Allowed Amount=Paid Amount + Patient Responsibility. var y=x.getYear() AOB is a document signed by patient, authorizing insurance payments directly to the provider or hospital for a patient’s treatment.

Copayment/Copay: A specified amount of money the patient must pay at each doctor's visit. Hope this has been a useful introduction to the world of medical terminology. Guarantor: Another term for insurance subscriber.

google_ad_client="ca-pub-2747199579955382";google_ad_slot="9869789507";google_ad_width=336;google_ad_height=280; Back from Medical Billing Glossary to General Information Premium is the amount, the insured or their employer pays (usually monthly) to the health insurance company for coverage. CMS, if you remember from Section 2, also maintains HCPCS codes. while a blood test that measures the how a Kidney is functioning will be called a Renal function test. The pleasant 'side effect' of learning these roots is that it not only expands your knowledge of medical words but boosts your vocabulary much much more even in non-medical terms. Find the meanings of medical billing jargons for a simpler understanding. Mayo Clinic will submit a claim to Medicare charging up to 15 percent over the Medicare approved amount. DME is medical supplies such as wheelchairs, oxygen, crutches, walkers, etc. The amount an insurance company will pay to reimburse a healthcare service or procedure. Patient can use any provider or hospital in this is a type of commercial insurance. drbj and sherry from south Florida on February 29, 2012: What a great idea, Docmo, to acquaint present and potential patients with the meaning of terms their physicians may use.

The patient will typically pay the balance if there is any remainder. This gives us time to think, assimilate and recall roots and rules, reflect on the usage and revisit familiar words with a new focus. Account Number: An identifying number for a patient in order to track medical visits. A Skilled Nursing Facility is an alternative to an extended hospital stay or home nursing care. May also be referred to as a chart or account number. A-Z Medical Billing Services, Inc is a forerunner in the Healthcare Industry with business & technology solutions designed to manage the revenue cycle, promote preparedness and interoperability, support incident response management and documentation for healthcare providers. I am in the middle of taking medical terminology online, and I found this to be VERY helpful! It is patient responsibility to update all his insurance carriers and the order of payment as which is the primary payer and which is the secondary payer. Fair Credit Reporting Act - Federal law that regulates the collection and use of consumer credit information.. Fair Debt Collection Practices Act (FDCPA) - Federal law that regulates creditor or collection agency practices when trying to collect on past due accounts. Mohan is a family physician and a Postgraduate Associate Dean working in the UK. Medicaid provides insurance coverage to low-income families and individuals.

Healthcare Provider is typically a physician, hospital, nursing facility, or laboratory that provides medical care services for a patient. When you close the collections month, how do you bill the physicians? Mohan Kumar (author) from UK on September 21, 2014: Thank you Delone, hope you like part 2 of this series too. Ancillary Services: Services rendered by the healthcare facility that are separate from the food and accommodation.

Search our directory of all medical billing and coding schools. ICD-10/Internation Classification of Disease, 10th Revision Codes: Alphanumerical codes given to specify a patient's diagnosis. Mixing your roots and prefixes/suffixes up is not considered a good idea. Whereas if the prefix ends in an 'a' then you add a 't' between the vowels. We’ll expand on a number of these topics in later courses. To my surprise I took the quiz and did well !! Predetermination is the payment insurance will pay for the services before treatment. while I am also keen of getting experience. Specialist is a one who specialized in a specific area of medicine. Subscriber: The person who pays for the insurance coverage, usually through a group employer plan. Workers Compensation is insurance that covers employee’s medical benefits and wages for work related injury or illness. 'For this hub is not just about learning and memorizing but about being able to logically work out what a term means by simple methods '. A digital version of the EOB, this document describes how much of a claim the insurance company will pay and, in the case of a denied claim, explains why the claim was returned.

I know you must have spent an awful amount of your time preparing this hub, but I tell you what -- it worth all the effort!

Those providers who accept the contract are known as Participating Provider or In Network Provider or Contracted Provider. Medical Record Number: A unique number that identifies a patient. Aging refers to the unpaid insurance claims or patient balances that are due past 30 days. When you do so you need to be armed with an accurate understanding of what you are searching for. This amount is applied directly to the patient's balance. CMS-1500: Claim form used in outpatient billing to send claims to insurance companies. It is used to define a name of the group by insurance company to identify insurance plan. Medicare Approved: Medical services which Medicare pays for. A type of insurance plan wherein patients are only eligible to receive health care within the insurance company’s network. Medical Billing Terms - Medical Billing Glossary. A government insurance program, founded in 1965, that provides healthcare coverage for persons over 65 years old and for people with disabilties. Non-Covered Charges/Services: Part of a medical bill that isn't covered by the patient's insurance. Insurance payments paid directly to the healthcare provider for medical services administered to the patient. It is an organization of physicians that are contracted with a HMO plan. Then there are simple rules that apply in combining these together to form a word.

Thanks for the visit and comment- always appreciated! Medical Terminology. Usually the account number is automatically assigned by the medical office's computer system. Medical Terminology Glossary; Research. You may wonder whether you would be able to learn what Doctors and Nurses learn after many years of studying and practising. Used for insurance billing purposes. Guarantor is a responsible party or insured party who is not a patient, responsible for paying a patient’s medical bill. This is a unique 9-digit number assigned to all the citizens of the USA. Do you have good knowledge of medical billing? Copay is the amount paid by patient at each visit as defined by the insured plan. Inpatient: When a patient is formally admitted to medical care in a facility, such as a hospital stay longer than 1 day.

Out-Of-Pocket Maximum: The maximum amount of money the patient has to pay themselves. For examples when a prefix ends in a vowel and the suffix begins with a vowel- you drop one when combing the two. Allowed amount is the amount allowed by the insurance towards each and every service. The 'A to Z' index of the medical terms contained in our database. I felt like i was back in anatomy 101..No kidding, this is a very educational hub.

How about a hub listing all the "ologist" professions and their purposes. List of Pre Existing Conditions,ACA-Obama Care,AHCA-Trump Care,BCRA, How to Obtain Premera Blue Cross Insurance Prior Authorization, Medical Billing Denial Codes and Solutions, Health Insurance in the United States of America, Primary Insurance and Secondary Insurance, Medicaid Provider Enrollment Phone Number, Denial Code CO 27 Expenses incurred after coverage terminated, Denial Code CO 11 The diagnosis is inconsistent with the procedure. But wait, If you thought you were getting away lightly from doing some homework, think again! HIPAA: Health Insurance Portability and Accountability Act. CMS is a Federal agency which administers Medicare, Medicaid, HIPPA, and other health programs. Claim Control Number: A number assigned to a claim that is used to process the claim.
Your email address will not be published. @ Amy - working in medical education I try ny best to instil patient centred care in my budding professionals - there are a lot of clinicians still who feel a well informed patient is a threat- I on the other hand think different- the actual threat to both parties is an ill- informed patient ! This usually goes by the Medicare policies and may vary with different insurance companies. It is also well known that not all medical professionals take the time to explain and inform clearly. A Medicare representative who processes Medicare claims. Copyright ©2020 www.medicalbillersandcoders.com All Rights Reserved.