medical billing basics
A patient who is not hospitalized
overnight but who visits a hospital,
clinic, or associated facility for
diagnosis or treatment.
Outpatient
Always primary except if there’s an HMO Medicare
Medicare
9-digit number assigned by the IRS to identify a medical entity—such as a clinic, hospital, or group practice—for billing and tax reporting
TIN , Tax ID
The contracted amount between the provider and the insurance.
Allowed amount
Insurance that we never bill as primary if another insurance is available
Medicaid
Person who is enrolled with an insurance company for medical coverage
Member
Provider that do not participate in health plan's network
Provider out of network
True or False: For Affinity by Molina insurance, if policy # is Medicaid number - Plan type: HMO Medicaid, if not we use PPO
True
Document sent by insurance companies to patients detailing how a medical claim was processed or paid
Explanation of Benefits (EOB)
Responsible for paying the patient's account bills
responsible carrier , insurance
True or False: When Medicaid HMO is the primary insurance, we do not add Medicaid as secondary,
but get the Medicaid ID and add it as the group # for the Medicaid HMO.
True
Aetna: W2314985240
Medicare: 6U18V25YT34
Healthfirst: 11658426487
based on the information above, which insurance is considered as secondary
Aetna
Meaning of HIPAA
Health Insurance Portability and Accountability Act
Meaning of LTC
Long Term Care
Medicare: 6U18V25YT34
Healthfirst: 808168541
Healthfirst: EF15393T
Healthfirst: 1015645482
Based on the information above, which insurance is considered as primary
Healthfirst