For more information on billing, coding and practice management or to set up training for your practice, visit Rheumatology or contact the ACR’s Practice Management Director Antanya Chung at [email protected].
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Get Familiar with Balance Billing Terminology
- Contracted Plan: An agreement between an insurer and a physician stating that the provider will accept a specific or contracted dollar amount for each service, regardless of what the provider actually charges for the service.
- Allowable: The contracted amount a physician agrees to accept as a complete reimbursement for a service. The allowable consists of the portion the insurance will pay and the portion the patient must pay.
- Write-off: The difference between the physician’s charge and the allowable, which may not be collected from either the patient or rebilled to the insurance plan.
- Accepting assignment: A physician who accepts assignment agrees to the insurance plan’s allowable and write-off amounts.
- In network: Providers or healthcare facilities that are part of a health plan’s network of providers with which it has negotiated a discount.
- Out of network: Refers to physicians, hospitals or other healthcare providers who are considered nonparticipants in an insurance plan (usually an HMO or PPO).
