GLOSSARY of Medical Billing terms
A
Accounts Receivable (AR): The total amount of money owed to a healthcare provider for services rendered that has not yet been paid by patients or insurance companies. Let us manage your accounts receivable effectively with our Accounts Receivable Follow-Up and Management Services.
Adjudication: The process by which an insurance payer reviews a claim and determines the amount of payment, if any, to be made.
Allowed Amount: The maximum amount an insurance company will pay for a covered healthcare service. Also known as the allowable charge, eligible expense, or negotiated rate.
B
Balance Billing: The practice of billing a patient for the difference between the provider’s charge and the insurance company’s allowed amount.
Bundling: The practice of combining multiple healthcare services into a single payment or charge.
C
Claim: A request for payment submitted to an insurance company by a healthcare provider for services rendered to a patient. Ensure accurate claim submissions with our Medical Billing Services.
Coinsurance: The percentage of the cost of a healthcare service that a patient is responsible for paying after the deductible has been met.
Denial: A refusal by an insurance company to pay for a healthcare service, often due to errors in the claim or lack of coverage.
Explanation of Benefits (EOB): A statement from an insurance company detailing what services were covered, the amount paid, and any patient responsibility.
H
I
M
N
Out-of-Network: Healthcare providers or facilities that do not have a contract with a patient’s insurance plan, often resulting in higher out-of-pocket costs for the patient.
Patient Responsibility: The portion of healthcare costs that a patient is responsible for paying, including deductibles, copayments, and coinsurance.
R
S
Third-Party Payer: An entity (other than the patient or healthcare provider) that pays for healthcare services, such as an insurance company or government program.
W
X12: A set of standards for electronic data interchange (EDI) used in healthcare transactions, such as claims and remittance advice.
