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Glossary of Professional Billing Concepts

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COPAY
Copay: Provision requiring policyholder to pay to a provider for each visit or service received.
COINSURANCE
Coinsurance: Percentage paid for covered services after deductible and the copayment paid.
CMS-1500
CMS-1500: Form used to submit Medicare claims; previously called the HCFA-1500
FEE SCHEDULE
List of predetermined payments for health care services provided to patients (e.g. a fee is assigned to each CPT code)
HCFA-1500
Now called the CMS-1500. Please see the definition for CMS-1500.
HEALTH CARE
Illnesses, injuries and medical concerns, but also include preventative services.
MEDICAL CARE
Identification of diseases, provision of care & treatment as provided by health providers to those who are sick, injured, or concerned health status.
LIEN
The right to take and hold or sell the property of a debtor as security or payment for a debt or duty.
SUBROGATION
The substitution of one person for another, especially the legal doctrine of substituting one creditor for another.
MINIMUM DATA SET
Data elements collected by long-term care facilities.
HEALTH MAINTENANCE ORGANIZATION
(HMO)
Responsible for providing health care services to subscribers in a given geographical area for a fixed fee.
BASE PERIOD
Period of time that usually covers 12 months and is divided into 4 consecutive quarters.
Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA)
CHAMPVA: Healthcare benefits for dependents of veterans:
A) rated as 100% permanently and totally disabled due to service-related conditions

B) veterans who died in service-related conditions

C) and veterans who died on duty with less than 30 days of active service.
Civilian Health and Medical Program - Uniformed Services
(CHAMPUS)
CHAMPUS:
A) Now known as TRICARE.
B) Benefits for dependents of those serving in armed forces and uniformed branches of the Public Health Service and the National Oceanic and Atmospheric Administration
DEDUCTIBLE
Amount for which the patient is financially responsible before an insurance agency provides coverage.

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