Billing Terms Glossary
Here are definitions of important billing terms.
Approved Amount - The amount of the hospital's charge that a payer will recognize in calculating benefits. (Under Medicare, also called "Medicare Allowable Charge")
Benefits Period - Starts the day you are admitted to a hospital or skilled nursing facility (SNF) and ends when you haven't received hospital inpatient or SNF care for 60 consecutive days.
Co-Insurance - The percent of the approved charge that you have to pay either after you pay the Part A deductible, or after you pay the first $100 deductible each year for Part B.
Co-Payment - A type of cost sharing whereby the insured person pays a specified flat amount per unit of service or unit of time (e.g., $10 per visit, $25 per inpatient hospital day), with the insurer paying the balance.
Deductible - The amount you must pay before Medicare begins to pay either each benefit period for Part A, or each year for part B.
Managed Care Plans - Managed care plans involve a group of doctors, hospitals who have agreed to provide care to Medicare beneficiaries in exchange for a fixed amount of money from Medicare every month.
Medicare Medical Savings Account - A Medicare health plan option made up of two parts. One part is a Medicare MSA Health Policy with a high deductible. The other part is a special savings account, called a Medicare MSA.
Original Medicare Plan - The traditional pay-per-visit arrangement that covers Part A and Part B services.
Private Fee-for-Service Plan - A private insurance plan that accepts Medicare beneficiaries.
Referral - Permission from your primary care doctor to see a certain specialist or receive certain services.
Supplemental Insurance Policy - Many private insurance companies sell Medicare Supplemental Insurance.
Urgently Need Care - Unexpected illness or injury that needs immediate medical attention, but is not life threatening.