General Billing Definitions

Co-Insurance or Co-Pays

Amount designated by the insurance as the patient's responsibility, usually reported as a percentage of the total amount billed.

Coordination of Benefit (COB) Rules

Determine which insurance is to be billed first (primary) for services when the patient is covered by more than one carrier. These rules are established by state and federal government guidelines

Deductible

Amount designated by the insurance as the patient's responsibility, reported as an amount that must be paid before insurance benefits begin.

Explanation of Benefits (EOB)

Is an itemized statement sent by your insurance company that details which services it has paid for and which services the insurer did not cover, along with an explanation.

Medicare Part A

Medicare Hospital Insurance, covering care in the hospital, any skilled nursing facility and/or for services from a home health agency.

Medicare Part B

Medicare Supplementary Medical Insurance, covering outpatient services for physicians, surgeons or any professional technician's fees.

Premiums

A set cost paid to your insurance to maintain coverage.

Primary Insurance

Designation given to the insurer that has first priority for payment of a claim.

Secondary Insurance

Designation given to the insurer that has second priority for payment after a claim, after the primary insurance pays or rejects services.

Tertiary Insurance

Designation given to the insurer that has third priority for payment of a claim, after both the primary insurance and secondary insurance pays or rejects a claim.

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