Insurance Terms & Billing review

Front

The out-of-pocket expenses that must be paid each year before the insurance company begins reimbursing for expenses

Back

Deductible

Answer explanation

Copay - Fixed amount patient pays per insurance policy

Coinsurance - percentage of the bill the patient pays

Front

An entity that pays for medical services, usually an insurance company

Back

Payer

Front

Healthcare Common Procedure Coding System

Back

HCPCS

Front

Practice of submitting a claim to a payer within a window of time specified in the contract with the provider

Back

Timely Filing

Front

A form signed by the patient when there is a possibility medical necessity guidelines may not be met based on Medicare coverage rules.

Back

Advanced Beneficiary Notice (ABN)

Answer explanation

Do you think Medicare is the only insurance who has a financial liability form such as the ABN?

Front

The amount a facility lists as the price for patient services

Back

Charges

Front

Charges added to a patient's account after the final bill

Back

Late Charges

Front

What patient type(s) must have CPT/HCPCS codes?

Back

Outpatient, OP

Answer explanation

Inpatient do NOT require CPT/HCPC codes.

Front

Describes when a patient pays out of pocket for health related services

Back

Self Pay

Front

An adjustment or discount that a hospital writes off due to a written agreement with the insurance company

Back

Contractual Adjustment