If you are considering working as a medical biller, or even starting a company in medical billing, there is a lot to learn. From EOB to HMO, it can become confusing without an index to reference. Here’s our guide to seven key terms every medical billing professional should know:
An appeal is a mechanism by which a patient or provider tries to compel an insurance payer to pay for a larger portion of a medical claim. An appeal takes place only after a claim has been denied or rejected upon submission.
Medicaid is an insurance program that provides coverage to low-income families and individuals. While Medicaid has federal requirements, each state determines Medicaid plans based on their local legislature.
Assignment of Benefits (AOB)
After a claim is submitted and successfully processed by an insurance company, the Assignment of Benefits are payments that the insurance company pays directly to healthcare providers.
Health Maintenance Organization (HMO)
A Health Maintenance Organization is a network of healthcare professionals that provide health insurance coverage for a fee. The patients are covered for medical services exclusively within that network of healthcare providers.
The CMS 1500 is a form that documents medical claims. When completed, CMS 1500 forms are submitted to Medicare and Medicaid. Many commercial insurance payers also require providers to use a CMS 1500 to submit their claims, making this one of the most common and significant tools in the process of medical billing.
Medicare is a government-funded insurance program that provides healthcare coverage to individuals over the age of 65, as well as individuals with disabilities. Founded in 1965, Medicare now covers more than 50 million people in the United States today.
Explanation of Benefits (EOB)
An Explanation of Benefits is a document within a claim that details which services an insurance company covers. Additionally, it explains what is incorrect on a claim if it is denied upon submission.
Now that you know more about common terms in the healthcare industry, you might be curious to learn more about medical billing. Check out our previous post to learn the difference between medical billing and coding, and stay tuned for next week’s blog installment.