A

Account:  Your charges for a medical visit.
Account Number:  Number you’re given by the hospital for a medical visit.
Actual Charge:  The amount of money charged for a certain medical service or supply. This amount is often more than the amount an insurance plan approves.
Adjustment: The portion of your bill that the hospital has agreed not to charge you.
Admission Date (Admit Date):  Date you were admitted for treatment.
Ambulatory Payment Classifications (APC):  A Medicare payment system that classifies outpatient services so Medicare can pay all hospitals the same amount.
Ambulatory Surgery: Outpatient surgery or surgery that does not require an overnight hospital stay
Amount Not Covered:  Amount your insurance company does not pay. It includes deductibles, co-insurances, and charges for non-covered services
Amount Payable by Plan:  How much your insurer pays for your treatment, minus any deductibles, coinsurance, or charges for non-covered services.
Ancillary Service:  Services you need beyond room and board charges, such as laboratory tests, therapy, surgery and the like.
Appeal:  A process by which you or your hospital can object to your health plan when you disagree with the health plan’s decision to not pay for your care
Applied to Deductible:  Portion of your bill, as defined by your insurance company, that you owe the hospital
Assignment of Benefits:  When the patient or guardian signs the Assignment of Benefits form so insurance payments are sent directly to the hospital.
Attending Physician Name:  The doctor who certifies that you need treatment and is responsible for your care
Authorization Number:  A number stating that your treatment has been approved by your insurance plan.  Also called a Pre-Authorization Number

B

Balance Bill:  How much the hospital charges you after your health plan, insurance company, or Medicare have paid its approved amount.
Beneficiary:  Person covered by health insurance.
Beneficiary Eligibility Verification:  A way for the hospital to get information about whether you have insurance coverage
Beneficiary Liability:  A statement that you are responsible for some treatments or charges
Benefit:  The amount your insurance company pays for medical services.

C

CHAMPUS:  Insurance linked to military service, also known as TriCare.
Charity Care:  Free or reduced-fee care for uninsured patients who meet eligibility criteria.
Claim:  Your medical bill that is sent to an insurance company for processing.
Claim Number:  A number given to a medical service.
COBRA Insurance:  Health insurance that you can buy when you lose your job. It is generally more expensive than insurance provided through your job but less expensive than insurance purchased on your own when you are unemployed.
Coding of Claims:  Translating diagnoses and procedures in your medical record into numbers that computers can understand.
Coinsurance:  The cost sharing part of your bill that you have to pay.
Coinsurance Days (Medicare):  Hospital Inpatient Medicare coverage from day 61 to day 90 of continuous hospitalization. You are responsible for paying for part of those days. After the 90th day, you enter your "Lifetime Reserve Days."
Collection Agency:   A business that collects money for unpaid bills.
Contractual Adjustment:  A part of your bill that the hospital must write off (not charge you) because of billing agreements with your insurance company.
Coordination of Benefits (COB):  A way to decide which insurance company is responsible for payment if you have more than one insurance plan.
Co-payment:  A cost-sharing arrangement of a health plan in which the patient pays a fixed fee for a specific service (such as $10.00 for an office visit). This fee does not vary with the cost of the service. Also referred to as co-insurance.
Covered Benefit:  A health service or item that is included in a health plan and that is partially or fully paid by the health plan
Covered Days:  Days that your insurance company pays for in full or in part.
CPT Codes:  A coding system used to describe what treatment or services were provided.
Current Account Balance:  Amount of money currently on the account

D

Date of Bill:  The date the bill for your services is prepared. It is not the same as the date of service.
Date of Service (DOS):  The date(s) when you were treated.
Days:  The total number of days that you are being charged for the hospital’s services.
Deductible:  How much cost sharing that you must pay for medical services often before your insurance company starts to pay
Description of Services:  Tells what the hospital did for you.
Diagnosis Code:  A code used for billing that describes your illness.
Diagnosis-Related Groups (DRGs):  A payment system for hospital bills. This system categorizes illnesses and medical procedures into groups for which hospitals are paid a fixed amount for each admission.
Discount:  Dollar amount taken off your bill, usually because of a contract with your hospital and your insurance company
Drugs/Self Administered:  Drugs that do not require doctors or nurses to help you when you take them. You may be charged for these. You will need to check with the hospital regarding the policy on this.
Due from Insurance:  How much money is due from your insurance company
Due from Patient: How much you owe the hospital

E

Eligible Payment Amount: Those medical services that an insurance company pays for.
Emergency Care:  Care given for a medical emergency when you believe that your health is in serious danger when every second counts.*
Estimated Insurance:  Estimated cost paid by your insurance company.
Enrollee: A person who is covered by health insurance.
Estimated Amount Due: How much the hospital estimates you or your insurance company owes.
Explanation of Benefits (EOB/EOMB):  The notice you receive from your insurance company after getting medical services from a doctor or hospital. It tells you what was billed, the payment amount approved by your insurance, the amount paid, and what you have to pay.

F

Federal Tax ID Number:  A number assigned by the federal government to hospitals for tax purposes.
Financial Responsibility:  How much of your bill you have to pay.
Fiscal Intermediary (FI):  A Medicare agent that processes Medicare claims.

G

Guarantor:  Someone who has agreed to pay the bill.

H

HCFA 1500 Billing Form (CMS):  A form used by doctors to file insurance claims for medical services.
HCPC Codes:  A coding system used to describe what treatment or services were given to you.
Health Care Financing Administration (HCFA):  Former name of the government agency now called the Centers for Medicare & Medicaid Services. Healthcare Provider:  Someone who provides medical services, such as doctors, hospitals, or laboratories. This term should not be confused with insurance companies that "provide" insurance.
Health Insurance:  Coverage that pays benefits for sickness or injury. It includes insurance for accidents, medical expenses, disabilities, or accidental death and dismemberment.
Health Maintenance Organization (HMO):  An insurance plan that pays for preventive and other medical services provided by a specific group of participating providers.
HIPAA: Health Insurance Portability and Accountability Act. This federal act sets standards for protecting the privacy of your health information.
Home Health Agency:  An agency that treats patients in their homes.
Hospice: Group that offers inpatient, outpatient, and home healthcare for terminally ill patients.
Hospital Inpatient Prospective Payment System (PPS):  A federal system that pays a fixed fee for inpatient care.

I

Inpatient (IP): Patients who stay overnight in the hospital.
Insurance Company Name: Name of the company that your claim will be sent to.
Insured Group Name: Name of the group or insurance plan that insures you, usually an employer.
Insured Group Number:  A number that your insurance company uses to identify the group under which you are insured.
Insured's Name (Beneficiary): The name of the insured person.
Itemized Bill: Printed summary of your medical bill.

L
Laboratory: Charges for blood tests and tests on body tissue samples, such as biopsies.
Lifetime Reserve Days (Medicare):  Under Medicare, you have a lifetime reserve of 60 more days of inpatient services after you use the first 90 benefit days. You must pay a fixed amount for each day of service.
Long-Term Care:  Care received in a nursing home. Medicare does not pay for long-term care unless you need skilled nursing or special rehabilitation.

M

Managed Care: An insurance plan that requires patients to see doctors and hospitals that have a contract with the managed care company, except in the case of medical emergencies or urgently needed care if you are out of the plan’s service area.
Medicaid: A state administered, federal and state funded insurance plan for low-income people who have limited or no insurance.
Medical Record Number: The number assigned by the hospital that identifies your individual medical record.
Medical/Surgical Supplies: Special supplies, such as materials used to repair a wound or instruments used for your care.
Medicare: A health insurance program for people age 65 and older. Medicare covers some people under age 65 who have disabilities or end-stage renal disease (ESRD).
Medicare Approved: Medical services for which Medicare normally pays.
Medicare Assignment: Doctors and hospitals that have accepted Medicare patients and agreed not to charge them more than Medicare has approved.
Medicare Number:  Every person covered under Medicare is assigned a number and issued a card for identification to providers.
Medicare Paid: The amount of your bill that Medicare paid.
Medicare Paid Provider: The amount of your bill that Medicare paid to the hospital.
Medicare Part A: Usually referred to as Hospital Insurance, it helps pay for inpatient care in hospitals and hospices, as well as some skilled nursing costs.
Medicare Part B: Helps pay for doctor services, outpatient care, and other medical services not paid for by Medicare Part A.
Medicare Summary Notice (MSN): The notice you receive from Medicare after getting services from the hospital. It tells you what was billed to Medicare, Medicare's approved payment, the amount Medicare paid, and what you have to pay. Also called an Explanation of Medicare Benefits (EOMB).
Medigap: Medicare Supplement Insurance that pays for some services not covered by Medicare A or B, including deductible and coinsurance amounts.

N

Network: A group of doctors, hospitals, pharmacies, and other health care experts hired by a health plan to take care of its members.
Non-Covered Charges:  Charges for medical services denied or excluded by your insurance. You may be billed for these charges.
Non-Participating Provider:  A doctor, hospital, or other healthcare provider that is not part of an insurance plan’s doctor or hospital network.
O
Observation: Type of service used by hospitals to decide whether you need inpatient hospital care or whether you can recover at home or in an outpatient area. Usually charged by the hour.
Out-of-Network Provider: A healthcare provider who is not part of an insurance plan's doctor or hospital network. Same as non-participating provider.
Out-of-Pocket Costs:  Costs you must pay because Medicare or other insurance does not cover them.
Outpatient (OP):  Patient who does not need to stay overnight in a hospital. Outpatient services include lab tests, x-rays, and some surgeries.
Outpatient Service: A service you receive in one day at a hospital or clinic without staying overnight.

P

Paid to Provider:  Amount the insurance company pays your medical provider. Paid to You: Amount the insurance company pays you or your guarantor.
Participating Provider:  A hospital that agrees to accept your insurance payment for covered services as payment in full, minus your deductibles, co-pays and coinsurance amounts.
Patient Amount Due:  The amount charged by the hospital that you have to pay.
Patient Type: A way to classify patients--outpatient, inpatient, etc.
Pay This Amount: How much of your bill you have to pay.
Per Diem: Charged or paid by the day.
Pharmacy Charges: Cost of drugs given under a pharmacist’s direction.
Point-of-Service Plan (POS): An insurance plan that allows you to choose doctors and hospitals without having to first get a referral from your primary care doctor.
Policy Number: A number that your insurance company gives you to identify your contract.
Pre-Admission Approval or Certification:  An agreement by your insurance company to pay for your medical treatment. Doctors and hospitals ask your insurance company for this approval before providing your medical treatment.
Pre-Existing Condition:  A health condition or medical problem that you already have before you sign up to receive insurance. Some health insurers may not pay for health conditions you already have.
Prepayments: Money you pay before getting medical care; also referred to as preadmission deposits.
Prevailing Charge:  A billing charge that is commonly made by doctors in a specific region or community. Your insurance company determines this charge.
Primary Insurance Company:  The insurance company responsible for paying your claim first. If you have another insurance company, it is referred to as the Secondary Insurance Company.
Procedure Code (CPT Code):  A code given to medical and surgical procedures and treatments.
Prospective Payment System (PPS):  A Medicare system that pays hospitals a set amount for covered diagnostic or treatment services.
Provider Contract Discount:  A part of your bill that the hospital must write off (not charge you) because of billing agreements with your insurance company.
Provider Name, Address, and Phone #: Name and address of the hospital submitting your bill.

Q

R

Reasonable and Customary (R & C): Billing charges that insurers believe are appropriate for services throughout a region or community
Referral:  Approval needed for care beyond that provided by your primary care doctor or hospital. For example, managed care plans usually require referrals from your primary care doctor to see specialists or for special procedures.
Release of Information:  A signed statement from patients or guarantors that allows doctors and hospitals to release medical information so that insurance companies can pay claims.
Responsible Party: The person(s) responsible for paying your hospital bill--usually referred to as the guarantor.
Revenue Code:  A billing code used to name a specific room, service (X-ray, laboratory), or billing sum.
Room and Board Private:  Routine charges for a room with one bed.
Room and Board Semiprivate:  Routine charges for a room with two beds.

S

Same-Day Surgery:  Outpatient surgery.
Secondary Insurance:  Extra insurance that may pay some charges not paid by your primary insurance company. Whether payment is made depends on your insurance benefits, your coverage, and your benefit coordination.
Service Area: Geographic area where your insurance plan enrolls members. In an HMO, it is also the area served by your doctor network and hospitals.
Service Code:  A code describing medical services you received.
Service Date:  Also known as To and From dates
Source of Admission: The source of your admission--referral, transfer, emergency room, etc.
Statement: Amount patient owes to the hospital.
Statement Covers Period: The date services or treatment begin and end.
Supplemental Insurance Company:  An additional insurance policy that handles claims for deductible and coinsurance reimbursement.

T

Total Charges: Total cost of your medical services.
Type of Admission:  The reason for your admission, such as emergency, urgent, elective, etc.
Type of Bill: A bill that shows what type of care is being billed, such as hospital inpatient, hospital outpatient, skilled nursing care, etc.

U

UB-92:  A form used by hospitals to file insurance claims for medical services.
Units of Service:  Measures of medical services, such as the number of hospital days, miles, pints of blood, kidney dialysis treatments, etc.
Utilization Review (UR):  Hospital staff who work with doctors to determine whether you can get care at a lower cost or as an outpatient.

V

W

Workers Compensation: Workers’ compensation is insurance, paid for by employers, that provides cash benefits and medical care if an employee becomes disabled because of an injury related to the employee’s job.

X

Y

You May be Billed: A phrase used by your insurance company informing you that the hospital may bill some charges directly to you

Z