Important Terms & Definitions

Groups of doctors, hospitals, and other healthcare providers, who come together voluntarily to give coordinated high quality care to their Medicare patients.

The amount an insurance company will pay to reimburse a healthcare service or procedure.  The patient will typically pay the balance if there is any remainder.

The process by which a patient or provider attempts to persuade an insurance payer to pay for more (or, in certain cases, pay for any) of a medical claim. The appeal on a claim only occurs after a claim has either been denied or rejected.

The amount of money a patient owes a healthcare provider that goes to paying their annual deductible. A patient’s deductible varies, and depends on that patient’s insurance policy.

Insurance payments paid directly to the healthcare provider for medical services administered to the patient. The assignment of benefits occurs after a claim has been successfully processed.

The practice of a healthcare provider billing a patient for the difference between what the patient's health insurance chooses to reimburse and what the provider chooses to charge.

The initial known value which is used for comparison with later data.  

An arrangement between a healthcare provider and an insurance payer that pays the provider a fixed sum for every patient they take on.  Capitated arrangements typically occur within HMOs. HMOs enlist patients to service providers, who are paid a certain amount based on the patient’s health risks, age, history, race, etc.

A federal agency that manages and oversees healthcare coverage through Medicare and Medicaid. CMS directly affects the healthcare of over 100 million Americans, and this number is growing every day.

The part of the nervous system that consists of the brain and the spinal cord. 

A type of insurance arrangement between the payer and the patient that divides the payment for medical services by percentage. While this is sometimes used synonymously with a co-pay, the arrangements are different: While a co-pay is a fixed amount the patient owes, in a co-insurance, the patient owes a fixed percentage of the bill. These percentages are always listed with the payer’s percentage first (e.g. a 70-30 co-insurance).

A fixed amount you pay for a covered heath care service after you have paid your deductible.   

The nerves of the brain, which emerge from or enter the skull.  There are 12 cranial nerves, each of which is accorded a Roman Numeral and a name.

A medical code set that is used to report medical, surgical, and diagnostic procedures and services to entities such as physicians, health insurance companies and accreditation organizations.

A specified amount of money that the insured must pay before an insurance company will pay a claim.

A conductor through which electricity enters or leaves an object, substance, or region.

A document attached to a processed claim, that explains to the provider and patient which services an insurance company will cover. EOBs may also explain what is wrong when a claim is denied.

A law passed in 1996 that has lasting effects on the healthcare industry today. Title I of the act protects workers’ health insurance when they change or lose jobs. Title II of the Act established standards and best practices in electronic health care.

A network of healthcare providers that offer coverage to patients for medical services exclusively within that network. 

Association of independent physicians, or other organization that contracts with independent physicians, and provides servcies to managed care organizations on a negotiated per capita rate, flat retainer fee, or negotiated fee-for-service basis.  

A type of insurance plan wherein patients are only eligible to receive healthcare within the insurance company’s network. HMOs and IPAS are examples of the managed care system.

Provides insurance coverage to low-income families and individuals. It is essentially an insurance program for those who cannot afford full insurance coverage. Medicaid is funded at state and federal levels, but each state has its own version of Medicaid, that must operate above the minimum requirements established by federal law.

Persons who do not have health insurance and who are not eligible for other healthcare coverage, such as Mediciad, Medicare, or private health insurance. 

A government insurance program, founded in 1965, that provides healthcare coverage for persons over 65 years old and for people with disabilities.  Medicare provides coverage to more than 50 million people in the United States today.

Decisions by Medicare and their administrative contractors that provide coverage information and determine whether services are reasonable and necessary on certain services offered by participating providers.

Connects one part of the nervous system with another via a bundle of axons, the long fibers of neurons.

When a provider is not contracted with the health insurance plan.

An AXIS Neuromonitoring associate whose primary responsibility is to assist patients.  The Patient Care Advocate is the patient's first and last point of contact throughout the scheduling and billing process.  

The nervous system outside the brain and spinal cord.

In this insurance plan, a patient in an HMO network can go to a physician outside of their network if they are referred there and pay a higher deductible. Think of this as a cross between an HMO and basic indemnity insurance.

A plan similar to an HMO, except that the insurance company, rather than the HMO itself, decides who is in the acceptable provider network. This is a common, subscription-based type of managed care.

Recording electrodes transfer electrical potentials at the recording site to the input of the recording machine.  

A person who pays out of pocket for health-related service in absence of insurance to cover the medical or surgical procedure performed. 

Formerly known as CHAMPUS, this is a federal health insurance plan for active service members, retired service members, and their families.

Sometimes called a “cafeteria plan,” this plan provides individuals who sign up the option of choosing between an HMO, PPO, or POS coverage.

A person or group of individuals who have no health insurance.