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Accept Assignment When a healthcare provider accepts as full payment the amount paid on a claim by the insurance company. This excludes patient responsible amounts such as coinsurance or copay.
Adjusted Claim When a claim is corrected which results in a credit or payment to the provider.
Aging Refers to unpaid insurance claims or patient balances that are due past 30 days. Most medical billing software can generate separate reports for insurance aging and patient aging. These reports typically list balances by 30, 60, 90, and 120-day increments.
Allowed Amount The reimbursement amount an insurance company will pay for a healthcare procedure. This amount varies depending on the patient’s insurance plan. For 80/20 insurance, the provider accepts 80% of the allowed amount and the patient pays the remaining 20%.
Ancillary Services Services a patient requires in a hospital setting that are in addition to room and board accommodations – such as surgery, lab tests, counseling, therapy, etc.
Appeal When an insurance plan does not pay for treatment, an appeal (either by the provider or patient) is the process of objecting this decision. The insurer may require documentation when processing an appeal.
Applied to Deductible (ATD) The amount of the charges, determined by the patient’s insurance plan, the patient owes the provider. Many plans have a maximum annual deductible that once met is then covered by the insurance provider.
Assignment of Benefits (AOB) Insurance payments that are paid directly to the doctor or hospital for a patient’s treatment. This is designated in Box 27 of the CMS-1500 claim form.
Authorization When a patient requires permission (or authorization) from the insurance company before receiving certain treatments or services.