MEDICAL FINANCING TERMS GLOSSARY

Healthcare has its own specialized jargon -- commonly used terms that are unfamiliar to people outside the industry. To put you on the inside track, we have included a glossary of some of the most commonly used terms and abbreviations.

Aged Trial Balance Summary -- Summary in dollars (by Payor Type) of the accounts that are current and overdue by: 30, 60, 90, 120 and 150 days up.

Batch -- An aggregate of accounts receivable purchased within a designated period of time (weekly, bimonthly, and monthly).

Cost Report Filing -- A reconciliation report submitted yearly to Medicare by the Provider.

Due Diligence -- Verification of facts about the provider, performed by the Medical Funding company before granting funding.

Durable Medical Equipment (DME) -- Medical equipment such as wheelchairs, hospital beds or oxygen concentrators.

Explanation of Benefit (EOB) -- A document defining conditions of payment on an insurance claim.

Gross Billing -- What the insurance company is billed; typically more than what is collected.

Health Maintenance Organization (HMO) -- A type of insurance plan.

Long-Term Care Facilities -- Special facilities providing care during extended stays such as nursing homes.

Medicare Offset -- An amount previously paid by Medicare to a Provider that exceeds the amount due. Subsequent Medicare claims will be paid when the account is reconciled.

Net collectable Value or Net Realizable Amount -- In the health care industry there is usually a substantial difference between the amount billed (gross) and the actual amount collected (net).  This amount is called NCV or NRA.

Estimated Net Receivable (ENR) -- The amount actually collected from an insurance company by the Provider.

Preferred Provider Organization (PPO) -- A type of insurance plan.

Personal Injury Claims -- Accident claims. These are significant, as they may not be paid promptly by the insurance company if the case is litigated.

Provider -- Any entity that provides a medical service (Such as a doctor, medical clinic, hospital, congregate care facility or other medical facility).

Self Pay -- The amount of the medical bill that the patient must pay out of pocket.

Skilled Nursing Facility -- Specialized outpatient facility usually associated with a hospital.

Third Party Payers -- Entities (other than patients) responsible for payment of a healthcare receivable. Examples are insurance companies, Medicare, Medicaid, CMOs, CHAMPS and Workers Compensation.