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Find the meaning of medical billing jargon for a simpler understanding

Adjudication

Final determination of an insurance claim.

Adjustment

Portion of bill doctor agrees not to charge.

Aging

Claims due past 30 days.

AMA

American Medical Association.

Ambulatory Care

Health services without overnight stay.

Ancillary Service

Extra services like lab, surgery, therapy.

Appeal

Doctor/patient disputes insurer’s decision.

Assignment

Transfer of insurance benefits.

Balance Billing

Provider bills patient for unpaid amount.

Beneficiary

Person covered by insurance.

Billing Cycle

Monthly billing period for claims.

Benefit

Service covered by health plan.

Broker

Agent who sells insurance plans.

Bundling

Grouping multiple services under one code.

Backlog

Unprocessed claims waiting.

Base Rate

Standard fee set for a service.

Claim

Request for payment to insurer.

Co-payment

Fixed amount paid by patient.

Coordination of Benefits

Sharing costs when two insurances apply.

Coverage

Extent of services insurance pays.

Coding

Assigning ICD/CPT codes to procedures.

Capitation

Fixed payment per patient.

Claim Status

Stage of claim processing.

Deductible

Amount paid by patient before insurance.

Eligibility

Patient’s coverage status.

Fee Schedule

List of maximum provider charges.

Guarantor

Person responsible for bill.

HCPCS

Healthcare Common Procedure Coding System.

ICD

International Classification of Diseases codes.

Job-Based Insurance

Coverage provided by employer.

Kennedy-Kassebaum Act

HIPAA law reference.

Lifetime Limit

Maximum insurance will ever pay.

Medicare

Federal insurance for elderly.

Network

Group of contracted providers.

Out-of-Pocket

Costs patient pays directly.

Premium

Monthly insurance payment.

Qualifying Life Event

Event allowing insurance changes.

Referral

Doctor’s order to see specialist.

Secondary Insurance

Backup coverage after primary.

Third-Party Payer

Insurance company paying bills.

Urgent Care

Immediate treatment outside ER.

Verification

Confirming patient eligibility.

Waiver

Written release of liability.

X-ray

Diagnostic imaging test.

Yearly Limit

Maximum annual payout.

Zero Balance

Account settled fully.