Terminologies
EOB
Explanation of Benefit
This federal health insurance program primarily covers individuals age 65 and older
Medicare
Who are the typical 3 parties in a claim?
Patients, Provider, Payer
This process confirms a PT's insurance coverage and benefits before the visit.
Insurance Verification
This standard claim form is used to bill professional or physician services.
CMS-1500 form
Fixed amount paid by PT at time of service
Copay
This program provides health coverage for low-income individuals and families and is jointly funded by state and federal government.
Medicaid
What document summarizes PT responsibility after a claim?
EOB
This form documents a PT's agreement to receive medical treatment
Consent Form
The provider's unique identification number issued by Medicare.
National Provider Identified (NPI)
Amount PT pays before insurance starts paying
Deductible
Medicare Part A mainly covers these types of services.
Inpatient/Hospital Services
In billing, what does POS refer to?
Place of service
A form signed by PT's allowing providers to release medical information
ROI
When a claim is returned unpaid due to incorrect or missing information
Rejected
Procedure/Service code used for billing
CPT Codes
This part of Medicare covers physician services, outpatient care and preventive services.
Part B
What does ICD-10 code describe?
Diagnosis
This is obtained to determine if a service requires approval before it is performed.
Prior Authorization
The portion of the bill that the PT responsible for paying
Patient Responsibility
AOB
Assignment of Benefit
This Madicare option is also known as Medicare Advantage
Medicare Part C
This type of plan requires member's to choose a primary care physician PCP
HMO
A notice given to Medicare PT when a service may not be covered.
Advance Beneficiary Notice (ABN)
Charges not covered because the provider is outside the Patient's Insurance network
Out-of-Network Charges