A/R - is an abbreviation for accounts receivable and means those accounts that are owed to you. In the medical office that means all the charges on the patients accounts.
Adjustment - generally this is referring to a contractual adjustment to the patient accounts that reduces the balance per your office agreement with certain insurance companies. For instance, when you participate with Medicare you are required to reduce the patient's charges for each visit to the allowed amount. Some companies may refer to this amount as a "Discount" on their EOB but it is a contractual adjustment.
Allowed Amount - that is the amount agreed to be charge for each procedure, test or visit type to the patient per the insurance company you have a contract with. For instance, your company charges $100 for a basice doctors office visit. The contract amount for a basic doctors office visit is $80 then you must write off $20 from the patient's account for that visit.
Coinsurance - This is the percentage amount of the allowed charges due by the patient. Usually the patient will have an out-of-pocket limit per year. Once that limit has been reached then the coinsurance due from the patient goes to zero. These amounts are almost always hard to compute at the time of service. So, unless you have only a few billing codes and procedures you will generally have to wait for the claims to process before you can inform the patient what he or she owes on the remaining balance of that service.
Copays - This is a set amount due for specific services and is set by the patient's insurance policy. This amount is separate from deductibles, c0-insurances and generally will always be due whether the patient reaches his or her out-of-pocket limits or not. For instance the patient owes $10 copay to see his or her primary care physician, $25 for a specialists visit, $100 for every Emergency Room visit and $45 for every urgent care center visit. These amounts vary by patient coverage and should always be collected before the patient leaves. They are almost always listed on the front of the patient's insurance card and are no surprise.
CPT - Current Procedural Terminology - These are the codes used in billing a procedure or office visit. They are determined by the American Medical Associated and grouped by type of procedure. They are also grouped by categories. Category I is the basic five digit codes dealing with the procedure and a description, Category II is intended to Measure Performance and Category III is for Emerging Technology. A full description of these categories is offered at the AMA CPT CATEGORY ARTICLE.
Deductible - The amount set by the patient's insurance that he or she must pay first before any claims will be paid by the insurance company. This amount is applied, generally, to the first claims received in the year per patient and is reduced by the allowed amount for that service. For instance, the patient has a $100 calendar year deductible, receives services at an emergency room on January 1st, the claim is for the total amount of $500 but the allowed amount for that service is only $100. In this case the entired allowed amount will be applied to the patient's deductible so that the next claim received by the insurance company for this patient will be processed at the percentage amount of allowed charges.
Discount - Generally referring to an agreed upon amount to reduce the patient's balance. Many medical offices and hospitals as well will offer a discount to self-pay patients who pay the bill up-front or make a set amount deposit for the type of services rendered. This is different from a "Contractual Adjustment" in that the agreement is between the patient and the medical facility itself. It should be coded differently in your Accounts Receivable system for accounting purposes as it is important to know the difference between insurance adjustments and patient discounts.
EOB - is an abbreviation for Explaination of Benefits. It is the form that is sent to your office along with the payment (if any) that lists the amount of the claim you sent on your patient's visits, the amount allowed (if any) of those charges, the adjustment due, and the amount paid for that service (if any). This form will give a reason if the claim is denied, has been applied toward the patient's deductible and a course of action if the claim can be reconsidered for payment.
HCPCS or Healthcare Common Procedure Coding System numbers are the codes used by Medicare (CMS: Centers for Medicare and Medicaid Services). There are two sets of codes. The first set, HCPCS Level I, are based on and identical to the CPT codes. Level II HCPCS codes are used by medical suppliers other than physicians, such as ambulance services or durable medical equipment.
ICD-9 or the International Classification of Diseases is the official system of assigning codes to diagnoses and procedures associated with hospital utilization in the United States. These are second part of the billing codes which must be chosen correctly in order to maximize the reimbursement for the doctors and medical facilities.
Out-of-Pocket Limit - An amount set by the terms of the patient's insurance contract. This usually based on the amount of coinsurance that the patient has paid. For instance, the patient has an out-of-pocket limit of $1,500 per year. The patient must pay a percentage of the allowed amount after meeting his/her yearly deductible untul the payments reach $1,500 then all claims will be paid at 100%.
Participation Discount - This is an agreed percentage adjustment to a patient's balance for being a member of a certain group. These are voluntary adjustments in that your medical facility has agreed to give these members a discount on services. This is not an insurance agreement and all payments are being made by the patient. You are giving the discount because the group has promised to refer their members to your practice and in return you agreed to apply a discount. The patients should have proof of membership through a card of some type and many look like insurance cards however on the back should be the words, "THIS IS NOT AN INSURANCE".
Registrar - Another name for Front Office Clerk, Admission Clerk, Patient Access Specialist, etc. This is the person who first encounters the patient in a medical facility. They are responsible for checking the patient in for their services. They are also responsbile for making sure all demographic and insurance information is correct in the system. Usually, they are the ones that will collect copays, update information and schedule return visits (in the case of doctors offices).