If you’re reading this blog, you are probably familiar with the vast world of medical terminology. It features an overwhelming amount of words, and it doesn’t matter if you’re working with parts of the human body or parts of a medical billing system—it’s confusing! At Complete Practice Resource, we have made it our mission to make the billing side of medicine a breeze so you can focus on the care side. We create incredible programs you can depend on, but we don’t stop there. We understand that knowledge is power, and that is why we work so hard to train our clients in medical billing. We are on a mission to give you and your team the tools you need to be the very best care providers in your area.
In the next few blogs, we are going to explore common medical billing terms and what they mean. Some or all may be familiar to you, but it’s always a good idea to review. Read on to learn!
This is a Medicare term, and it refers to the limit on how much they will pay per year per patient. If a patient goes beyond the utilization limit and needs another procedure, Medicare might not cover it.
This is the dollar amount that any insurance company will pay to reimburse you as a care provider. It changes depending on the company and the plan. If there is a remaining balance after the insurance company pays the allowed amount, the patient will have to pay it.
If you have patients who have served in the military, TRICARE will be their insurance provider. TRICARE also provides insurance for their families. Whether the service member is active or retired, they are eligible for TRICARE.
Before insurance will step in, the patient has to pay some amount of money. This is called a deductible, and it changes depending on the insurance policy and the insurance company. Once the client has paid the deductible, the insurance company covers the rest of the charges.
Applied to Deductible (ATD)
This is the money that comes directly from the client and goes into the deductible. As we said, the money that needs to be ATD will change depending on the policy.
Triple Option Plan (TOP)
This type of insurance plan opens things up to patients and gives them the choice between a Health Maintenance Organization (HMO), a Preferred Provider Organization (PPO), and Point of Service (POS). It is often called the “cafeteria plan” because it gives so many options.
Assignment of Benefits (AOB)
This term refers to payment from an insurance company to a healthcare provider. It is paid for services received by the patients. It is determined after a claim has been processed successfully.
As you probably know, Medicaid is insurance coverage for low-income individuals and families. It receives its funding at federal and state levels, and each state has its own version of it. Each state must keep its Medicaid program functioning above minimum requirements determined on the federal level.
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