BILLING ESSENTIALS

2. A process completed before claims submission in which claims are examined for accuracy and completeness.
5. The process of determining if a procedure or service is covered by the insurance plan and what the reimbursement is for that procedure or service.
6. - Meeting the stipulated requirements to participate in the healthcare plan.
7. Software that finds common billing errors before the claim is sent to the insurance company.
9. A document sent by the insurance company to the provider and the patient explaining the allowed charge amount, the amount reimbursed for services, and the patient's financial responsibilities.
10. A payment arrangement for healthcare providers. The provider is paid a set amount for each enrolled person assigned to him or her, per period of time, whether or not that person has received services.

1. To settle or determine judicially.
3. An organization that accepts the claim data from the provider, reformats the data to meet the specifications outlined by the insurance plan, and submits the claim.
4. An identifier assigned by the Centers for Medicare and Medicaid Services (CMS) that classifies the healthcare provider by license and medical specialties.
8. A set dollar amount that the patient must pay for each office visit. There can be one copayment amount for a primary care provider, a different copayment amount (usually higher) to see a specialist or be seen in the emergency department.