Billing Basics
What does “EOB” stand for in medical billing?
Explanation of Benefits
What is a “deductible”?
The amount a patient pays before insurance starts covering costs
What does “HIPAA” stand for?
Health Insurance Portability and Accountability Act.
What does “ICD” stand for?
International Classification of Diseases.
What is a “co-pay”?
A fixed amount a patient pays for a service.
In billing, what does “POS” mean?
Place of Service.
What does “pre-authorization” mean?
Approval from the insurer before certain services are provided.
Why is it important to follow HIPAA?
To protect patient privacy and avoid penalties.
What is a CPT code used for?
To identify medical procedures for billing.
Define “reimbursement” in billing.
Payment from insurance for services provided.
Who is responsible for billing patient co-pays?
The provider’s billing office.
What is a “network” in health insurance?
A group of providers contracted with an insurance plan
Define “fraud” in billing.
Intentionally submitting incorrect claims to receive payment.
Define “modifier” in coding.
Additional information about a service provided.
What is an “adjustment” on a bill?
A reduction in the billed amount based on insurance agreements.
What is the purpose of a claim form?
To submit details of services provided for reimbursement.
Define “out-of-pocket maximum.
The most a patient pays in a year before insurance covers 100%.
What is “upcoding”?
Billing for a higher-cost service than was provided.
What’s the purpose of an “HCPCS” code?
To identify non-physician services like equipment.
What’s an “allowed amount”?
The maximum an insurance plan will pay for a service.
Define "Superbill
A document listing rendered services and codes for insurance submission.
What is “coordination of benefits”?
Determining primary and secondary insurance coverage.
What organization investigates Medicare fraud?
Office of Inspector General (OIG).
How often are ICD codes updated?
Annually
What is a “write-off”?
The portion of a bill a provider agrees not to charge.