Insurance Terms
A method of cost sharing in which the subscriber is responsible for a specified percentage of the cost of healthcare under fee-for-service plans. Plans where the insured is responsible for 20% while the insurance will cover 80% are fairly typical. Frequently there is a maximum amount the insured is required to pay, called a stop loss amount.
Coinsurance
The process of entering information into the EHR system to enroll a person as a patient by creating a patient record.
Registration
A written order from your primary care doctor for you to see a specialist or get certain medical service.
Referral
Provides coverage for individuals injured on the job.
Worker's Compensation
The inappropriate acquisition access to and use or disclosure of unsecured patients medical information in a manner not permitted under HIPAA regulations.
Breach
A fixed out of pocket amount you pay for a specific covered healthcare service or prescription drug, usually required at the time of service.
Copayment "Co-pay"
MRN
Medical Record Number
A request by you for payment by the insurance company of medical expenses that are covered under the insurance policy.
Claim
DOI
Date of Injury
MSPQ
Medicare Secondary Payor Questionnaire
The fixed annual amount you must pay out of pocket for covered medical services before your insurance plan begins to pay. After meeting this amount, you typically only pay a copayment or coinsurance for services.
Deductible
Documents indicating a patient's wishes in the event they become incapacitated and unable to make decisions regarding their own medical care.
Advanced Directive
The release, transfer, provision of access to, or divulging in any other manner of information outside the entity holding the information.
Disclosure
POE
Place of Employment
The charges generated as Patients are given care.
Revenue
Amount paid prior to services based on the estimated balance left to patient responsibility per the patient's healthcare plan.
Prepayment
an electronic record of patient health information generated by one or more encounters for a single healthcare organization.
Electronic Medical Record
A health insurance plan or another entity that processes and pays healthcare bills may be called a third party payer, payer, carrier, or insurer. These terms are interchangeable.
Third Party Payer- Payer- Carrier- Insurer
TPL
Third Party Liability
The amount of cash paid to the provider by health insurance plans, other payers, and patients for healthcare services.
Reimbursement
Your health insurance of plan may require this for certain services before you receive them, except in an emergency. It is not a promise from your health insurance or plan that they will cover the cost.
Pre-authorization
Some minors are emancipated, meaning they have been released from their parent's control and supervision and are responsible for themselves. These minors are their own guarantors.
Emancipated
DOS
Date of Service
Person/Entity who is responsible for payment of the bill.
Guarantor
A company that manages and administers health insurance plans on behalf of an employer or insurance company, but does not assume the financial risk of paying claims. For example, they process claims, verify eligibility, and manage customer service.
TPA/Third Party Administrator