Glossary of Terms

1. A - D


2. E - I


3. J - Z

This glossary will help you understand some of the typical terms used in the billing process.

A - D

Ancillary Service	Adjacent to, or in addition to your visit or medical service; anesthesia, laboratory, radiology, etc.
Adjudication	Payment of a claim according to benefits.
Bill	Charges for a specific visit.
Claim	A detail coded bill sent to the patient's insurance company.
Co-Pay	Amount designated by the insurance company as the responsibility of the insured, usually per visit.
Co-Insurance	A percentage for the total approved amount on an insurance claim.
Coordination of Benefits (COB)	Rules that determine which insurance is to be billed first (primary) for services when patient is covered by more than one carrier. State and Federal guidelines apply.
Deductible	An amount designated by the insurance company as the patient's responsibility.
Demographics	Address information of the patient.
DME	Durable medical equipment

E - I

Explanation of Benefits (EOB)	Itemized statement from your insurance company detailing which services are covered.
Facility	The hospital where services are performed.
Guarantor	The person or persons responsible for payment must be 18 years or older and legally competent.
Home Care	Medical services provided to a patient in their home.

J - Z

Medicare Part A	Medicare hospital insurance covering care in the hospital, at any skilled nursing facility and from a home health agency.
Medicare Part B	Medicare supplementary medical insurance covering outpatient services from physicians, surgeons or any professional technicians.
Primary Insurance	Designation given to the insurer that has first priority for payment of a claim.
Provider / Physician	The professional doctor, therapists, nurse practitioner, etc. providing service to the patient.
Statement	A periodic summary of the accounts for the patient or family.