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Fairbanks Memorial Hospital & Denali Center
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Glossary of Billing Terms
FMH/DC:
Glossary of Billing Terms
Return to Patient Financial Services
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Account
- Charges for a medical visit
Account Number
- Number given by a doctor or hospital for a medical visit
Adjustment
- The portion of a medical bill for which a doctor or hospital has agreed not to charge
Admission Date (Admit Date)
- Date patient admitted for treatment
Admission Hour
- Hour when admitted for inpatient or outpatient care
Admitting Diagnosis
- Words that a doctor uses to describe a medical condition
Advance Beneficiary Notice (ABN)
- A notice the hospital or doctor gives before treating a Medicare patient, telling them that Medicare will not pay for some treatment or services. The notice is given so that Medicare patients are aware of non-covered treatment or services, and may decide before treatment is provided whether to proceed with the treatment and how to pay for it
Advance Directive (Healthcare)
- Written prior to treatment, a healthcare advance directive is a document that says how a patient would like medical decisions to be made if the patient loses the ability to make decisions. A healthcare advance directive may include a living will and a durable power of attorney for health care
Amount Charged
- The amount a doctor or hospital bills a patient
Amount Not Covered
- What an insurance company does not pay. It includes deductibles, co-insurances and charges for non-covered services.
Amount Paid
- The dollar amount a patient pays for a doctor or hospital visit
Amount Payable by Plan
- How much an insurer pays for patient treatment, minus any deductibles, coinsurance or charges for non-covered services
Anesthesia
- Drugs given to a patient during surgery to eliminate or reduce pain resulting from the surgical procedure
Appeal
- The process by which a patient, doctor, or hospital can disagree with the health plan's decision to not pay for care
Applied to Deductible
- Portion of a patient's bill, as defined by an insurance company, that he or she owes a doctor or hospital
Attending Physician Name
- The doctor who certifies that a patient needs treatment and is responsible for the patient's care
Assignment
- An agreement a patient signs that allows an insurance company to pay a doctor or hospital
Assignment of Benefits (AOB)
- When insurance payments are sent directly to a doctor or hospital
Authorization Number
- A number stating that a patient's treatment has been approved by his or her insurance plan. Also called a certification number or prior-authorization number
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Balance Bill
- How much doctors and hospitals charge a patient after the patient's health plan, insurance company or Medicare has paid its approved amount
Beneficiary
- Person covered by health insurance
Beneficiary Eligibility Verification
- A way for doctors and hospitals to get information about whether a patient has insurance coverage
Beneficiary Liability
- A statement that a patient is responsible for some treatments or charges
Benefit
- The amount an insurance company pays for medical services
Bill/Invoice/Statement
- Printed summary of a medical bill
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Claim
- A medical bill that is sent to an insurance company for processing
Claim Number
- A number given to a medical service
Coinsurance
- The cost-sharing part of a bill that a patient has to pay
Co-pay
- Agreed amount of the charges for medical services that patients or guarantors must pay
Consent (for treatment)
- An agreement signed by a patient giving permission to receive medical services or treatment from doctors or hospitals
Contractual Adjustment
- A part of a patient's bill that a doctor or hospital must write-off (not charge for) because of billing agreements with the insurance company
Coordination of Benefits (COB)
- A way to decide which insurance company is responsible for payment if a patient has more than one insurance plan
Co-payment
- A cost-sharing part of a bill that is a patient's responsibility to pay, also known as co-pay
Covered Benefit
- A health service or item that is included in a health plan, and that is paid for either partially or fully
Covered Days
- Days that an insurance company pays for in full or in part
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Deductible
- How much cost-sharing a patient must pay for medical services, often before the insurance company starts to pay
Discharge Hour
- Time of day when a patient was discharged
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Enrollee
- A person who is covered by health insurance
Explanation of Benefits (EOB/EOMB)
- The notice received by a patient from an insurance company after receiving medical services from a doctor or hospital. It details what was billed, the payment amount approved by insurance, the amount paid, and the amount to pay
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Financial Assistance
- Assistance for patients who have financial hardship and difficulty paying their medical bill
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Guarantor
- The person responsible for paying the patient's bill. Typically, the guarantor is the patient's parent or guardian
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Healthcare Provider
- Someone who provides medical services, such as doctors, hospitals or laboratories. This term should not be confused with insurance companies, that provide insurance
HIPAA
- Health Insurance Portability and Accountability Act. This federal act sets standards for protecting the privacy of patient health information
Home Health Agency
- An agency that treats patients in their homes
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Insured Group Name
- Name of the group or insurance plan that insures an individual, usually an employer
Insured Group Number
- A number that an insurance company uses to identify the group under which a patient is insured
Insured's Name (Beneficiary)
- The name of the insured person
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Non-Covered Charges
- Charges for medical services denied or excluded by an insurance company. A patient may be billed for these charges
Non-Participating Provider
- A doctor, hospital or other healthcare provider who is not part of an insurance plan's doctor or hospital network
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Out-Of-Pocket Costs
- Costs a patient is responsible for because their insurance does not cover them
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Paid To Provider
- Amount the insurance company pays a medical provider directly
Paid To You
- Amount the insurance company pays the patient or guarantor
Participating Provider
- A doctor or hospital that agrees to accept an insurance payment for covered services as payment in full, minus the patient's deductibles, co-pays and coinsurance amounts
Patient Amount Due
- The amount charged by a doctor or hospital for which the patient is responsible
Pre-Existing Condition
- A health condition or medical problem that a patient already has before receiving insurance. Some health insurers may not pay for pre-existing health conditions
Pre-payments
- Money a patient pays before getting medical care; also referred to as pre-admission deposits
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Release of Information
- A signed statement from a patient or guarantor that allows doctors and hospitals to release medical information
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Secondary Insurance
- Extra insurance that may pay some charges not paid by a patient's primary insurance company. Whether payment is made depends on insurance benefits, insurance coverage and benefit coordination
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Total Charges
- Total cost of medical services
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UB-92
- A form used by hospitals to file insurance claims for medical services
Return to Patient Financial Services
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