There are so many things that we’re not meant to fully understand, like modern art and the stock market. We want to tell you about a few things that you may not understand about medical billing, but absolutely should.
- Explanation of Benefits (EOB)
- We’ve all received one of these, but don’t really know what it is. It’s not a bill but feels like one. It’s the insurer’s explanation of how a provider will be paid for a claim, as it relates to the patient’s insurance policy. It’s an outline of what the insurer is paying and what the patient may need to pay, if at all.
- CPT Codes
- Current Procedural Codes identify the medical procedures or services that were performed.
- Deductible
- The dollar amount that the patient is responsible for paying prior to the insurance paying for medical services in a policy year.
- Copay
- A fixed fee that a patient pays for a medical service. This is usually applied to medical appointments, but can also be for tests, urgent care visits, and emergency room or other services.
- Coinsurance
- Once a patient satisfies their deductible, this will come into play. This is the percentage of the allowed amount a patient is responsible to pay for any service provided.
- Cost-sharing
- A general term used to describe any fee that a patient is responsible for paying per their insurance policy. Inclusive of coinsurance, deductible, and copays.
- Out-of-pocket Maximum
- The out-of-pocket maximum a patient must pay for covered medical services in any policy year. Once this maximum is met the patient’s insurance policy pays 100% of all allowed amounts for any covered service you receive for the remainder of the policy year.
- Ineligible Services
- Services that are not covered by your policy for some particular reason. The service may be excluded by your policy or get bundled with something that is not covered or is out-of-network.
- Bundling
- When billing codes are put together to be paid as one, they are bundled. These are treated as if they are one code.
- Coordination of Benefits (COB)
- The process insurance companies undertake to determine who has the responsibility of paying for medical claims. Could apply when you have more than one insurance policy and need the determination of who holds the primary and secondary policy.
If you’d like more help with your billing, or to get the first-class services of a medical billing company that gets your claims paid and processed, give our team at Gables Medical Billing a call.
