Clean ClaimĪ claim received by an insurance payer that is free from errors and processed is a timely manner. HMOs enlist patients to service providers, who are paid a certain amount based on the patient’s health risks, age, history, race, etc. Capitated arrangements typically occur within HMOs (See “Health Maintenance Organization (HMO)”). CapitationĪn arrangement between a healthcare provider and an insurance payer that pays the provider a fixed sum for every patient they take on. The assignment of benefits occurs after a claim has been successfully process. Insurance payments paid directly to the healthcare provider for medical services administered to the patient. A patient’s deductible varies, and depends on that patient’s insurance policy. The amount of money a patient owes a healthcare provider that goes to paying their annual deductible (See “Deductible”). The appeal on a claim only occurs after a claim has either been denied or rejected (See “Rejected Claim” and “Denied Claim”). The process by which a patient or provider attempts to persuade an insurance payer to pay for more (or, in certain cases, pay for any) of a medical claim. The patient will typically pay the balance if there is any remainder. The amount an insurance company will pay to reimburse a healthcare service or procedure. For a fuller list of medical billing vocabulary, download our ebook. We’ll expand on a number of these topics in later courses. In this course, you’ll learn about some of the key terms and concepts in the medical billing field. Like medical coding, the profession of medical billing has its own specific vocabulary.
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