EOU (Explanation of Benefits) A statement that describes medical benefits and account activity, including an explanation of why certain claims may or may not have been paid. N/A Fees not covered. Any medical service that does not cover a patient`s insurance. Invoice code used to designate a specific room, service, or bill amount. Early deposit If the insurance payer authorizes the submission of a medical claim within the specified time limit, but all claims filed after that date are denied. […] Flow, but also prevents problems. Therefore, it is necessary to understand the intricacies of the medical billing system in order to ensure better reimbursements_ so that you are able to provide quality care for your […] Medical Record Number A unique number assigned to each patient by the health care provider to identify the patient`s record. Measures of the medical services a patient has received, such as the number of days in hospital, blood injections, treatments or laboratory tests. A type of insurance plan that only requires patients to consult providers (doctors and hospitals) who have a contract with the managed care company, except in the case of medical emergencies or emergency care when the patient is outside the plan`s service area. A medical or surgical unit of a hospital that cares for patients who need more care than a general or surgical medical unit can provide.
A payment system used by many insurance companies for hospital bills. This system classifies diseases and medical interventions into groups. Hospitals receive a fixed amount for each admission. Part of a hospital that treats patients with urgent or urgent medical problems. Responsible Party A person, group or company responsible for paying a patient`s medical bill. Also known as guarantor. A portion of your bill that your provider must write off due to billing agreements with your insurance company. ICD-9 codes are an international set of codes that represent diagnoses of patients` medical conditions as determined by physicians. Medical billing specialists can translate a doctor`s diagnoses into ICD-9 codes and then enter those codes into a treatment request. Billing The process by which medical bills are collected from insurance companies in hospitals or other healthcare facilities. The standard claim form used by institutional providers such as hospitals to bill insurance companies for medical services.
Adjustment The portion of the medical bill that the physician or hospital has agreed not to bill the patient. Medical devices that can be used multiple times, or special devices ordered by your doctor, usually for home use. Fee Schedule A list of the maximum fees that a health plan pays for services based on CPT billing codes. HCPCS A set of medical codes selected for use in HIPAA transactions identifies healthcare procedures, equipment, and consumables for filing claims. HCPCS Level I contains numerical CPT codes maintained by WADA. HCPCS Level II contains alphanumeric codes used to identify various elements and services not included in the CPT medical code set. These are maintained by HCFA, BCBSA and HIAA. HCPCS Level III contains alphanumeric codes assigned by state Medicaid agencies to identify additional items and services not included in Levels I or II. A doctor who specializes in treating certain body parts or medical conditions. For example, a cardiologist only treats patients with heart problems. Military service insurance. ChampVA shares the costs of certain medically necessary procedures and supplies with eligible beneficiaries.
ChampVA does not have a network of healthcare providers, so eligible members can visit most authorized providers. The money you pay before receiving medical care; Also known as a pre-admission deposit. The Office of the Inspector General of the Office of the Inspector General of the Office of the Inspector General is part of the Department of Health and Human Services. It establishes compliance requirements for billing services as well as individual and medical practices to reduce fraud and abuse in healthcare. Party that provides medical services, such as hospitals, doctors or laboratories. In general, the price charged by the supplier. In particular, a fee for a given service is considered „customary and customary” if it falls within the range of prices charged by other providers in the same geographical area for the same service. Health Insurance Portability and Accountability Act (HIPAA): This law, passed in 1996, helps preserve the confidentiality of patients` medical records. A set of standards has also been created that all electronic medical records must meet. Pre-existing condition (CEP) A patient who is diagnosed with a medical condition before starting insurance coverage. The CEP cannot be covered by an insurer for a specified period as a specified insurance contract.
Fees for medical services that are denied or excluded by your insurance. You may be charged this fee. A hospital or doctor who provides medical care to the patient. Your medical bill, which is sent to an insurance company for payment. Practice Management Software Software used in a healthcare provider`s office for planning and billing. An account with a highly deductible health plan that allows you to set aside pre-tax dollars to pay for your deductible medical expenses or other eligible medical expenses. Contributions are transferred to the account by the individual`s individual or employer and are limited to a maximum amount per year. Unlike a flexible spending account, funds are extended and accumulate year after year if not spent. A statement sent to you by your insurance company after they processed a claim sent to them by a provider. The EOU will indicate the amount invoiced, the amount authorised, the amount paid to the supplier and any co-payments, deductibles or co-insurance owed by you. The EOU can detail the medical performance activity of an individual or family.
Medical necessity Any medical procedure that is not of an examination, aesthetic or experimental nature, but that is performed to treat an illness or injury. Diagnostic code A billing code that describes your illness The amount of money charged by the hospital for a particular medical service or care. Balance bill The amount that doctors must bill patients after the patient`s insurance and health insurance have paid because the fees are higher than the usual and usual rate, or because the insurer considers a procedure medically unnecessary The number assigned by your doctor or hospital that identifies your individual medical record. A statement signed by patients or guarantors that allows providers to disclose medical information so that insurance companies can pay claims. Helps pay for medical, ambulatory care, and other medical services not paid for by Medicare Part A. Medical Billing Specialist You process insurance claims for payment for services provided by a physician or other health care provider. Ensures that the patient`s medical billing codes, diagnostic and insurance information are correctly entered and transmitted to the insurance payer. Enter insurance payment information and process patient bills and payments.
Performs tasks essential to the financial functioning of a firm. The date your medical services or treatments began. Translate clinical information from your medical record into numbers (such as diagnostic and procedure codes) that insurance companies use to pay claims. Audit of the utilization review (UR) performed to minimize redundant medical services for inpatients or ambulatory patients. A medical condition for which the patient has been treated for some time before purchasing a new insurance plan. This period (e.g. 30, 60, 90 days, 6 months, etc.) prior to registration is referred to as a review. The term „treatment” is defined as receiving medical advice, referrals, prescription medications, diagnosis or treatment. Under the Affordable Care Act, exclusions from pre-existing conditions are no longer allowed, with one exception: for individual plans (which were not purchased through an employer) that existed prior to 2010 and included such inclusion. Bill/Bill/Statesmen Printed summary of patients` medical bills.
Hi Jitendra, thank you very much for this post. This article will benefit our understanding of hospital medical billing.