Insurance Terms & Billing review

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

• Copay

• Coinsurance

• EOB

• Deductible

Answer explanation

Copay - Fixed amount patient pays per insurance policy

Coinsurance - percentage of the bill the patient pays

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

• SSC

• Payer

• Subscriber

• Guarantor

Healthcare Common Procedure Coding System

• CPT

• HCPCS

• Modifier

• Revenue Code

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

• Timely Filing

• in-network

• predetermination

• Ancillary Services

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

• Advanced Beneficiary Notice (ABN)

• Referral

• Precertification

• Financial Waiver

Answer explanation

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

The amount a facility lists as the price for patient services

• UCR

• coinsurance

• Charges

• Allowed Amount

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

• Rebill

• Deductible

• Late Charges

• Bill Type

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

Answer explanation

Inpatient do NOT require CPT/HCPC codes.

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

• Primary Payer

• Guarantor

• Self Pay

• Tertiary

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

• Allowed Amount

• Remittance Advise

• COB

• Contractual Adjustment