Glossary of billing terms
Advance Beneficiary Notice (ABN): A form signed by the patient before certain services are rendered, notifying him or her that Medicare may not cover this service and that the patient will be responsible for payment. The ABN was previously called the Medicare Medical Necessity Waiver.
Balance: The amount owed to Mayo Clinic indicated on the billing statement.
Commercial health insurance: Private insurance. A basic, traditional insurance contract.
Copayment/coinsurance: An amount established by the insurance company as the patient's responsibility of billed fees.
Credit balance: This balance appears in the "Amount Due" column of your statement with a minus sign after the amount (for example, $100-). Mayo Clinic may owe a refund to the patient or insurance plan, dependent upon review of the account.
Deductible: An amount determined by the insurance company to be paid on an annual basis before benefits are paid.
DOS: Date of service.
Elective services: Any service that is not emergency care. With few exceptions, cosmetic procedures are elective services and must be prepaid by the patient.
Explanation of Benefits (EOB) or Medicare Summary Notice: A document provided by the patient's insurance plan or Medicare detailing how benefits are processed and paid for services rendered.
Health insurance claim form (HCFA 1500): Health-claim form (red and white form) sent to the primary or secondary insurance carrier.
Non-covered services: A service not covered under the limits of the patient's health insurance contract. These amounts are the patient's responsibility to pay. Patients should direct questions about coverage to their health plan.
Nonparticipation: A health-care provider that chooses not to accept the Medicare-approved amount as payment in full.
Pre-care deposit: When applicable, a dollar amount predetermined by Mayo Clinic to be paid before your visit.
Pre-certification: Requirement of your insurance company to determine medical necessity for services rendered. Pre-certification does not guarantee benefits for payment. Benefits are based on policy provisions in force at the time services are rendered. Questions about pre-certification requirements in your contract should be directed to your insurance plan.
Proof of health insurance: A valid insurance card including the address where claims are to be filed.
Registration: Areas in the lobbies of the Davis and Cannaday buildings and Mayo Primary Care Centers where all patients report to be assigned a Mayo Clinic medical record and billing account number. Here they can also receive information about payment, billing and filing insurance. All address, phone and insurance changes should be updated at Registration.
Self-pay patient: A person who has no insurance or does not want the services rendered to be filed with his or her insurance company. This patient must make a pre-care deposit.
Statement: A record of account status (blue and white form) sent to patients monthly to patients to advise of the previous period's transactions and activity on the account.
Supplemental/secondary claimform: If you have supplemental/secondary insurance, Mayo Clinic will submit claims to those carriers on your behalf.
Uninsured patient: A patient without medical insurance. Uninsured patients are required to make a pre-care deposit.
Usual, customary and reasonable (UCR): Predetermined allowable limits used by insurance carriers to limit the maximum amount they will pay on a given service as governed by their contract with the patient. Please note that Mayo does not accept predetermined UCR health-insurance amounts for health plans with which we do not participate.
Utilization limits: Medicare sets limits on how many times some services can be provided in a year. If services exceed this utilization limit, your claim could be denied. These limits are not disclosed to Mayo Clinic.
Jan. 08, 2015