Account number - number the patient's visit (account) is assigned by the hospital for documentation and billing purposes.

Adjustment/contractual adjustment - the portion of the bill that the hospital has agreed not to charge the beneficiary because of billing agreements they have with the beneficiary's insurance company.   Also referred to as a discount.

Admitting diagnosis - the medical reason the patient was admitted to the hospital.

Advance Beneficiary Notice (ABN) - a notice the hospital gives the patient before they receive services when Medicare is not expected to pay for some or all of the services.   The notice allows the patient to decide whether to have the services since they will be responsible for payment if Medicare denies the charges.  ABNs apply to patients with traditional Medicare only.  They do not apply to patients with Medicare+Choice coverage.

Advance directive - a written document, such as a living will or durable power of attorney, that expresses how the patient wants medical decisions to be made if they permanently lose the ability to make decisions for themselves.

Ambulatory care - outpatient services.

APC (Ambulatory Payment Classification) - a Medicare system for grouping and classifying similar outpatient services and procedures for purposes of payment.

Appeal - a process by which the patient, their doctor, or the hospital can object to the insurance company's decision not to pay for care.

Applied to deductible - portion of the bill the insurance company requires the beneficiary to pay the hospital.   See also deductible.

Assignment of benefits - a process under which insurance pays its share of charges directly to the hospital, doctor, or supplier rather than the beneficiary.   See also benefit.

Authorization number - a reference number provided when service has been approved by insurance.   Also called a certification number or prior-authorization number.   See also pre-admission approval/certification.

Beneficiary - the person who is covered by (i.e., eligible for or receiving benefits from) an insurance policy or plan.

Beneficiary/patient liability - the amount beneficiaries must pay out-of-pocket for medical services, including co-payments, co-insurance, and deductibles.  This amount is in addition to the amount paid by insurance

Benefit - the amount insurance pays for medical services.

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