MEDICAL BILLING TERMS QUESTIONS
AND ANSWERS WITH SOLUTIONS 2024
actual charge - ANSWER the amount of money charged by the health care provider or supplier for a
certain medical service or supply. Often more than medicate or third part payers approve
allowable charge - ANSWER generic term referring to the maximum fee that a third part will use to
reimburse a provider for a given service
balance bill - ANSWER balance billing is the practice of billing a patient for charges not paid by his/her
insurance plan because the charges are in excess of covered amounts. balance billing amount will often
be charges beyond the fee schedule or contract rate
beneficiary - ANSWER a person who is covered by a third party payer
claim - ANSWER a request for payment for service provided by a health care provider
Centers for Medicare and Medicaid Services (CMS) - ANSWER federal agency within United States
department of health and human services that administers the medicare program and works in
partnership with state governments to administer medicaid, the state children's health insurance
program and heath insurance portability standards
coordination of benefits COB - ANSWER the sharing of costs by two or more health plans, based on their
respective financial responsibilities for medical claims.
a primary insurance and a secondary insurance must coordinate benefits in order to pay claims. if one of
the plans is medicare, federal law may decide who pays first.
copayment - ANSWER a set amount determined by the third party payer that the insured pays to a
provider for the treatment or service
covered services - ANSWER a service or supply, specified in contract, for which benefits will be provided
pursuant to terms of the contract
AND ANSWERS WITH SOLUTIONS 2024
actual charge - ANSWER the amount of money charged by the health care provider or supplier for a
certain medical service or supply. Often more than medicate or third part payers approve
allowable charge - ANSWER generic term referring to the maximum fee that a third part will use to
reimburse a provider for a given service
balance bill - ANSWER balance billing is the practice of billing a patient for charges not paid by his/her
insurance plan because the charges are in excess of covered amounts. balance billing amount will often
be charges beyond the fee schedule or contract rate
beneficiary - ANSWER a person who is covered by a third party payer
claim - ANSWER a request for payment for service provided by a health care provider
Centers for Medicare and Medicaid Services (CMS) - ANSWER federal agency within United States
department of health and human services that administers the medicare program and works in
partnership with state governments to administer medicaid, the state children's health insurance
program and heath insurance portability standards
coordination of benefits COB - ANSWER the sharing of costs by two or more health plans, based on their
respective financial responsibilities for medical claims.
a primary insurance and a secondary insurance must coordinate benefits in order to pay claims. if one of
the plans is medicare, federal law may decide who pays first.
copayment - ANSWER a set amount determined by the third party payer that the insured pays to a
provider for the treatment or service
covered services - ANSWER a service or supply, specified in contract, for which benefits will be provided
pursuant to terms of the contract
