Modern advances in technology, research and new operating methods have greatly reduced the need for overnight hospitalization for surgical patients.
1. Faster recovery means less discomfort.
2. Recovery in the comfort of the patients own home.
3. Reduction in the cost of healthcare.
Amount Charged - how much your doctor or hospital bills you.
Amount Not Covered - What your insurance company does not pay. It includes deductibles, co-insurances, and charges for non-covered services.
Amount Payable by Plan - How much your insurer pays for your treatment, minus any deductibles, coinsurance, or charges for non-covered services.
Adjustment: The portion of the bill that the doctor or hospital has agreed not to charge you.
Contractual adjustment : The difference between total/actual charges and the amount of money approved by the insurance company (third-party payor). Contractual Adjustment is also called ‘Contractual Allowance’, ‘Provider’s Write-off’, or ‘Provider’s Discount’.(or)
A part of your bill that your doctor or hospital must write off (not charge you) because of billing agreements with your insurance company.
Write-off : Despite all the efforts provider was not able to realize cash from insurance company for the claims or charges, which were denied. These claims or charges need to be written off as the denial is due to providers fault/mistake.
Co-insurance: A fixed percentage a patient pays for services received after a deductible and co-payment have been paid; the insurance company pays the remaining percentage.
Co-Payment: A small, fixed amount a patient directly pays a provider for specific services. It is a upfront payment a patient has to pay every time a patient visits a physician or hospital. Also called flat rate fee.
Non-Covered Services: Services or procedures not covered by the third party payor under patient’s policy. Services which are not reasonable and customary and do not meet requirements for being medically necessary.
Premiums: The regular payment a person makes to an insurance company to obtain health coverage. Premium has to be paid even if the policyholder does not visit a provider in the coverage period.
Authorization Number - A number stating that your treatment has been approved by your insurance plan. Also called a Certification Number or Prior-Authorization Number.
Beneficiary - Person covered by health insurance.
CHAMPUS - Insurance linked to military service, also know as TriCare.
Claim - Your medical bill that is sent to an insurance company for processing.
Coding of Claims – Translating diagnoses and procedures in your medical record into numbers
that computers can understand.
Coordination of Benefits (COB) - A way to decide which insurance company is responsible for payment if you have more than one insurance plan.
CPT Codes - A coding system used to describe what treatment or services were given to you by your doctor.
Date of Service (DOS) - The date(s) when you were treated
Diagnosis Code - A code used for billing that describes your illness.
Eligible Payment Amount - Those medical services that an insurance company pays for.
Estimated Insurance - Estimated cost paid by your insurance company.
Enrollee - A person who is covered by health insurance.
Explanation of Benefits (EOB/EOMB) - The notice you receive from your insurance company after getting medical services from a doctor or hospital. It tells you what was billed, the payment amount approved by your insurance, the amount paid, and what you have to pay.
HCFA 1500 Billing Form (CMS) - A form used by doctors to file insurance claims for medical services.
Health Care Financing Administration (HCFA) - Former name of the government agency now called the Centers for Medicare & Medicaid Services.
Healthcare Provider: Someone who provides medical services, such as doctors, hospitals, or laboratories. This term should not be confused with insurance companies that "provide" insurance.
Health Insurance: Coverage that pays benefits for sickness or injury. It includes insurance for accidents, medical expenses, disabilities, or accidental death and dismemberment. (or)
Health insurance is a mechanism to reduce individuals risk of incurring high medical expenses in the future that
he may be unable to pay in the event of some contingency such as death, accident, or illness. In order to cover,
these possible future medical expenses a person pays periodic payments (premiums), to an
insurance company.
1. Faster recovery means less discomfort.
2. Recovery in the comfort of the patients own home.
3. Reduction in the cost of healthcare.
Amount Charged - how much your doctor or hospital bills you.
Amount Not Covered - What your insurance company does not pay. It includes deductibles, co-insurances, and charges for non-covered services.
Amount Payable by Plan - How much your insurer pays for your treatment, minus any deductibles, coinsurance, or charges for non-covered services.
Adjustment: The portion of the bill that the doctor or hospital has agreed not to charge you.
Contractual adjustment : The difference between total/actual charges and the amount of money approved by the insurance company (third-party payor). Contractual Adjustment is also called ‘Contractual Allowance’, ‘Provider’s Write-off’, or ‘Provider’s Discount’.(or)
A part of your bill that your doctor or hospital must write off (not charge you) because of billing agreements with your insurance company.
Write-off : Despite all the efforts provider was not able to realize cash from insurance company for the claims or charges, which were denied. These claims or charges need to be written off as the denial is due to providers fault/mistake.
Co-insurance: A fixed percentage a patient pays for services received after a deductible and co-payment have been paid; the insurance company pays the remaining percentage.
Co-Payment: A small, fixed amount a patient directly pays a provider for specific services. It is a upfront payment a patient has to pay every time a patient visits a physician or hospital. Also called flat rate fee.
Non-Covered Services: Services or procedures not covered by the third party payor under patient’s policy. Services which are not reasonable and customary and do not meet requirements for being medically necessary.
Premiums: The regular payment a person makes to an insurance company to obtain health coverage. Premium has to be paid even if the policyholder does not visit a provider in the coverage period.
Authorization Number - A number stating that your treatment has been approved by your insurance plan. Also called a Certification Number or Prior-Authorization Number.
Beneficiary - Person covered by health insurance.
CHAMPUS - Insurance linked to military service, also know as TriCare.
Claim - Your medical bill that is sent to an insurance company for processing.
Coding of Claims – Translating diagnoses and procedures in your medical record into numbers
that computers can understand.
Coordination of Benefits (COB) - A way to decide which insurance company is responsible for payment if you have more than one insurance plan.
CPT Codes - A coding system used to describe what treatment or services were given to you by your doctor.
Date of Service (DOS) - The date(s) when you were treated
Diagnosis Code - A code used for billing that describes your illness.
Eligible Payment Amount - Those medical services that an insurance company pays for.
Estimated Insurance - Estimated cost paid by your insurance company.
Enrollee - A person who is covered by health insurance.
Explanation of Benefits (EOB/EOMB) - The notice you receive from your insurance company after getting medical services from a doctor or hospital. It tells you what was billed, the payment amount approved by your insurance, the amount paid, and what you have to pay.
HCFA 1500 Billing Form (CMS) - A form used by doctors to file insurance claims for medical services.
Health Care Financing Administration (HCFA) - Former name of the government agency now called the Centers for Medicare & Medicaid Services.
Healthcare Provider: Someone who provides medical services, such as doctors, hospitals, or laboratories. This term should not be confused with insurance companies that "provide" insurance.
Health Insurance: Coverage that pays benefits for sickness or injury. It includes insurance for accidents, medical expenses, disabilities, or accidental death and dismemberment. (or)
Health insurance is a mechanism to reduce individuals risk of incurring high medical expenses in the future that
he may be unable to pay in the event of some contingency such as death, accident, or illness. In order to cover,
these possible future medical expenses a person pays periodic payments (premiums), to an
insurance company.
No comments:
Post a Comment