Appeal ✔️✔️An appeal is a special kind of complaint made when a beneficiary or provider
disagrees with decisions about health care services typically related to payment issues. There is
usually a special process used to appeal a payor decisions.
Appropriate Care ✔️✔️A diagnostic or treatment measure whose expected health benefits
exceed its expected health risks by a wide enough margin to justify the measure.
Assignment of Benefits ✔️✔️Written authorization from the policyholder to their insurance
company to pay benefits directly to the care provider. Normally acquired at the time of
admission or registration.
Attending Physician ✔️✔️The physician who writes outpatient orders for tests, or supervises
the patient's care during an inpatient stay.
Authorization ✔️✔️Approval obtained from an insurance carrier for a service that represents
an agreement for payment.
Authorization to release medical information ✔️✔️The form authorizing to release information
from the medical records to doctors, hospitals, insurance, other agencies, etc.
, Average Daily Census ✔️✔️The average number of inpatients maintained in the hospital for
each day foe a specific period of time.
Average length of stay ✔️✔️The average number of days of service rendered to each patient
during a specific time period.
Bad Debt ✔️✔️An accounts receivable that is regarded as uncollectible and is charged as a
credit loss even though the patient has the ability to pay.
Balance Billing ✔️✔️The practice of billing a patient for the fee amount remaining after
insurer payment and co-payment have been made.
Batch Billing ✔️✔️Information technology term referring to grouping similar input items and
then processing them together during a single machine run.
Behavioral Health ✔️✔️Assessment and treatment of mental and/or psychoactive substance
abuse disorders.
Beneficiary ✔️✔️Person designated to receive the proceeds of an insurance policy. The
insured under a health insurance policy. Also referred to as eligibility, enrollee, or member. Any
person eligible as either a subscriber or a dependent for a managed care service in accordance
with a contract.