MDA 145 Vocabulary - Billing and Coding
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14 Terms
Premium
The amount the policyholder pays for benefits
Benefits
Payments for medical services for a specific time period
Dependents
Spouse or children
Clearinghouse
They scrub or clean claims to ensure correct coding
Deductible
Annual fixed dollar amount to be paid by the policyholder in addition to premium
Coinsurance
A fixed percentage of covered charges after the deductible is met
Copayment
Fixed fee collected at the time of service
Birthday Rule
The plan of the person whose birthday comes first is the primary
Precertification
Process of confirming with insurance that specific services are covered under the plan
Preauthorization
Approval from the insurance company for services due to medical necessity
Fee Schedule
List of usual prices for medical services
Fee For Service
Pay the provider for all services based on the fee schedule
Allowed Charge
The maximum amount a plan will pay a provider for medical services
Diagnosis Code
Primary condition for which a patient is being treated