Medical billing is a complex process that involves many specialized terms and concepts. Understanding medical billing terminology is essential for medical billing professionals and healthcare providers. This glossary provides a comprehensive list of medical billing terminology and concepts.
- Adjudication: The process of determining whether a claim for medical services will be paid by an insurance company or government program.
- Allowed amount: The maximum amount that an insurance company or government program will pay for a medical service.
- Appeal: A request for a review of a denied claim.
- Assignment of Benefits: An agreement between a healthcare provider and an insurance company or government program to pay the healthcare provider directly for medical services rendered to a patient.
- Claim: A request for payment for medical services rendered to a patient.
- CMS-1500: The standard claim form used for billing Medicare and Medicaid.
- Coordination of Benefits: The process of determining which insurance company or government program is responsible for paying for medical services rendered to a patient.
- Copayment: A fixed amount that a patient must pay for medical services.
- Current Procedural Terminology (CPT): The coding system used to describe medical procedures and services.
- Deductible: The amount that a patient must pay before insurance coverage begins.
- Denial: The refusal to pay for medical services by an insurance company or government program.
- Diagnosis-related group (DRG): A coding system used to classify hospital cases into groups for payment purposes.