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welcome to lesson two now I just wanted to cover some more common terminology and acronyms used in medical billing coding before I moved on to some of the other topics the adjudication process refers to the processing and settlement of claims by insurance payer for their rules and guidelines that's once the claim reaches the payer and is accepted by the payer appeal process that's the process of objecting to an insurance payers decision to deny a dis payment assignment of benefits for the insurance payments to a healthcare provider on behalf of the patient for their treatment beneficiary that's the person covered by the health insurance plan that is receiving the benefits the Clearing House is a service that transmits advisor claims to each individual carrier after checking for claim errors copay that's the amount paid by patient in each visit per their contract with the insurance plan coinsurance that's the percentage amount to find an insurance plan for which the patient is responsible this may be expressed in terms of percentages like ninety ten or eighty twenty or that lower percentage is the patient responsibility coordination of benefits sometimes they bring me in to see OB that's the coordination insurance coverage when a patient is covered by more than one insurance plan you need to determine which is primary insurance and which is secondary insurance and there are rules for determining that we get into an fundamentals course in more detail credentialing that's the application process for a provider to participate in an insurance carriers plan a program to be a network provider a crossover claim is one of claims processed by the primary insurance carrier and then sent electronically directly to the secondary translator the CMS 1500 that is the primary form used to submit medical claims and it's established by the CMS Centers for Medicare and Medicaid Services to submit claims to insurance payers add a sheet that's a daily summary of patient treatments charges and payments for a physician's office did suitable that's the amount the patient must pay before the insurance coverage gets you now continuation of terminology the fee schedule this refers to a schedule of all the treatment codes that a physician uses in the cost associated with those a guarantor that is the responsible party in or the insured party who is not the patient the inpatient refers to a hospital state of more than 24 hours insured is the person through which the health insurance policy is issued a modifier is a modifier to me sympathy treatment code that provides additional information on any modifications made to the treat that treatment code medical necessity you'll see this term used a lot and that's the determination of whether a service or procedure that was performed is medically necessary or determined to be medically necessary by an insurance payer Medicare that is the insurance provided by the federal government for people over 65 and those with certain other restrictions like kidney...