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The following is a list of terms that you may find useful when reviewing this document:

 

Company

Billing service, MSO, or physician practice

Practice

The clients of a company

Division

One or more taxable entities of a practice

Physician

.An individual who is licensed to practice medicine in accordance to the laws of the state in which they practice

 

Assistant

An individual who is licensed or certified to assist a physician in the practice of medicine.  An assistant may be a Physicians Assistant, Nurse Practitioner, Certified Registered Nurse Anesthetist, Anesthesia Assistant, etc.

 

Facility

The hospital, surgery center, or office where services were rendered.  Generally a street address.

 

Location

The place of service (HCFA/CMS) where the service was rendered.  May be the same or a different street address as the facility.

 

O/R Suite

Operating Suite or Room in the facility where the service was rendered.

 

Patient

The person to whom the physician is providing medical services

 

Account

The person or entity who is legally and/or financially responsible for the patient.

 

Subscriber

The person who is holds the insurance under which medical services provided to the patient will be billed.

 

Carrier

Insurance company, Health Maintenance Organization, Self-Insured Corporation, or Healthcare Intermediary.

 

Plan

Maintains contract parameters, calculation of billed and allowed fees and claims submission criteria.

 

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Policy

 

The "intersection" of a plan, a patient and a subscriber.