Patient Billing Glossary
Account number: A unique number assigned to you to group charges for your hospital visit. A new account number is assigned for each visit, so you may have several account numbers. Also referred to as a patient account number.
Account balance: The portion of charges for your stay for which you are responsible. Payments from insurers and other adjustments are deducted from your total charges to get this balance.
Account summary: The box found in the lower right of patient bills showing the total charges for your visit, payments received and adjustments made, your current account balance and payment due date.
Authorization: Permission to provide a treatment or service from your insurance company, Medicare, Medicaid or other financially responsible person or group.
Average Length of Stay: The average number of days a patient stays at the hospital. (Calculation: Total # of patient days divided by the # of discharges for a given period.)
Birthday rule: For children covered by two parents' insurance, this rule determines which insurance is considered primary based on the parents' birth month and day. Generally, insurance from the parent whose birthday is earlier in the year will be considered primary.
Complication: A secondary disease or reaction to treatment that occurred during your visit, and may have worsened your condition or illness.
Comorbidity: A secondary disease or condition you may have along with your primary disease or condition. For example, if you have diabetes and high blood pressure, diabetes may be your primary disease, but high blood pressure could be a comorbidity.
CPT (Current Procedural Terminology) Codes: Universal five digit codes used by all insurance companies, hospitals and physicians to identify the type of care you receive. Insurance companies use these codes, along with a diagnosis, to determine payment and reimbursement for your claims.
Deductible: If you have insurance or Medicare, you may be required to pay a certain amount of money (called a deductible) for health care services before your insurer will pay for your care. Deductibles often start over every plan year and may apply only to some treatments or procedures.
Diagnosis: Your disease, injury, or condition.
DRG (Diagnosis Related Group) Codes: Codes hospitals use to classify patient cases for Medicare billing purposes. The codes take diagnosis, treatment, age, gender, reason for discharge and any complications or comorbidities into account and determine how much Medicare will pay for treatment. Some private insurers also use these codes.
EOB: Explanation of Benefits. A common name for the statement sent from an insurance company to their customer that explains the benefit they have received, or how much the insurance company paid for medical treatments on a patients behalf. They are not bills — medical providers must bill patients for any outstanding charges separately.
ICD-10: The term for primary diagnosis codes, also called International Statistical Classification of Diseases and Related Health Problems. These are seven-digit codes all hospitals use to classify and indicate patients' primary diagnoses on bills. They are used for both inpatient and outpatient services.
Inpatient visit: A visit to the hospital for treatment that begins when you are formally admitted to the hospital by a doctor. Visits to hospital emergency rooms or involving stays for observation or tests are not considered inpatient unless a doctor formally orders your admission, even if you stay overnight.
Medicaid: A government-funded health insurance program for people of any age who meet certain low-income guidelines. Each state has different eligibility guidelines, which determine how much of your treatment cost the program will cover. For more details on Florida's eligibility guidelines, click here.
Medicare: A federal health insurance program for all people 65 years or older, some disabled persons and those with end-state renal disease. Medicare requires patients to pay for some of their health care through premiums, deductibles and other expenses. It has four parts: A, B, C or Medicare Advantage Plan, and D. Medicare is the same in all states.
Medicare Part A: The part of Medicare that helps cover charges for in-patient hospital or skilled nursing facility stays, hospice and home health services. Most people over the age of 65 do not pay a premium for Medicare Part A insurance because they have paid Medicare taxes during their working years. Disabled people under 65 may also be covered by Medicare Part A.
Medicare Part B: The part of Medicare that helps cover charges for doctors' services, outpatient care, some home health services, and other similar medical services. It also includes some outpatient visits to the emergency room and some preventive services. Participation in Part B is optional. Check your Medicare card to find out if you are enrolled in Part B.
Medicare Advantage Plans /Medicare Part C: Medical plans provided by private insurers, approved by Medicare. The plans provide both your Medicare Part A and B coverage, and may provide additional coverage for some medical services.
Medicare Part D: The part of Medicare that helps cover prescription costs.
MSN: Medicare Summary Notice. A statement patients receive from Medicare showing services and supplies billed to Medicare, what Medicare paid, and what patients may owe medical providers. MSNs are mailed every three months. They are not bills — medical providers must bill patients for any outstanding charges separately.
Outpatient Procedure: A treatment or observation done in a hospital or medical office that does not require you to be formally admitted to the hospital, even if you stay overnight.
Service location: The hospital or office where you received your care.
Third party payer: An entity that may pay some or all medical charges for a patient. Examples include Medicare, Medicaid and private insurance companies. If you are involved in an auto accident, it may also mean another driver's insurance company.
Zero balance account: A patient account on which no money is owed by the patient, Medicare or supplemental insurance.