Billing Questions: What do these terms means?

ABN- (Advanced Beneficiary Notice) a waiver by patient when there is reason to believe that the service will not be paid by Medicare.

APC- (Ambulatory Payment Classification) an outpatient reimbursement methodology that groups procedures into like categories and assigns a payment rate to each category.

Co-pay- Amount to be paid by patient (or secondary insurance, if applicable) estimated by the insurance company. It varies based on type of service.

Cross-Over- For certain secondary insurances, Medicare will send the claim directly to the other insurance and the hospital will not need to send anything.

DRG- (Diagnostic Related Groupers) inpatient reimbursement methodology that groups inpatient conditions into like categories and assign a rate to each category.

EOB- (Explanation of Benefits) notification from your insurance company what was paid to the doctor or hospital.

Medicare HMO- Patients have the option to have another insurance company pay for their medical bills in place of Medicare. Examples: Independent Health Encompass 65; Univera Senior Choice.

MSP- (Medicare Secondary Payor) doctors and hospitals are required to ask patient specific questions to determine if the patient may be covered by a health plan other than Medicare. Medicare is not always the primary payor.

Pre-authorization- For certain tests, insurance companies require doctors to obtain permission from them before the test can be ordered.