Medical Billing and Coding Glossary Terms. If you're interested in medical insurance billing and coding as a profession, the following terms can help you learn more about this exciting industry. At the very least, they can help you understand the common practices and industry terms that a medical biller or coder should know. AMA - The American Medical Association serves the largest association of doctors in the United States.
This organization, widely known and respected, publishes The Journal of the American Medical Association. Aging - A medical billing term that refers to unpaid insurance claims that become past due. Assignment of Benefits - These are the insurances paid to a hospital or doctor for services rendered to a patient. Beneficiary - The person covered by a health insurance plan is the beneficiary. CMS 1. 50. 0 - Created by the Centers for Medicaid and Medicare Services (CMS), this medical claim form (red ink) allows for the submission of paper claims to Medicare and Medicaid.
Coding - This is the process of taking a doctor's notes about a patient and transcribing them in the proper ICD- 9 code (defined below). Collection Ratio - Every health care provider has accounts receivable. This ratio is determined by the payments received compared to the total amount of money owed on the account. Coordination of Benefits - Some patients are covered by more than one insurance plan. One of the plans is chosen as the primary plan and the other as the secondary. Copay - The amount a patient is required to pay at each visit as determined by his or her insurance plan.
Deductible - This is the amount a patient must pay before insurance coverage begins. Electronic Claim - Claim information is sent directly to the insurance carrier via electronic transfer. Enrollee - A person enrolled in a health insurance plan. EPO - An exclusive provider organization (EPO). Where employers agree not to contract with other plans, is a type of managed care plan that combines features of HMOs and PPOs. EOB - Explanation of benefits. A statement sent by the insured's health care provider that explains the treatment and services they will pay.
Group Name - This is the name of the patient's insurance carrier. Group Number - Insurance companies assign each insured patient a number that references a group plan. Health Care Insurance - Coverage that helps to manage the cost of patient medical care. Health Care Provider - Typically refers to a hospital, physician or health care facility that provides health care services.
Medical Terminology and Medical Billing. In medical terms. This does not mean that medical coding and billing are complicated. Like medical coding, the profession of medical billing has its own specific vocabulary. In this course, you’ll learn about some of the key terms and concepts in the. What Is Medical Billing and Coding? And Other Frequently Asked Questions. In order to grasp the medical terms and medical billing codes.
HIPAA - The Health Insurance Portability and Accountability Act provides coverage for family members of workers who have lost or changed jobs. HMO - A health maintenance organization (HMO) is an organization that provides or arranges managed care for health insurance, self- funded health care benefit plans, individuals and other entities on a prepaid basis.
A comprehensive collection of Medical Billing Terms and acronyms used by the Medical Insurance Specialist and coder. Here we've compiled a glossary of terms and. 2.02: Medical Coding Vocabulary & Key Terms. The terminology used in medical coding can seem intimidating, but it doesn’t have to be. Watch this course video and. Medical Billing and Coding Glossary Terms. If you're interested in medical insurance billing and coding as a profession, the following terms can help you learn more. Vocabulary words for Career Step IP/OP Medical Billing and Coding. Includes studying games and tools such as flashcards.
ICD- 9- CM and ICD- 1. CM Code (International Classification of Diseases, 9th or 1. Revision, Clinical Modification coding system) - An international classification of diseases that are assigned codes to patient diagnosis. Inpatient - A patient who is admitted to the hospital and stays overnight or for an indeterminate time.
Medical Coder - Professionals who analyze patient charts and who assign appropriate ICD- 9- CM and ICD- 1. CM codes. Medical Billing Specialist - A person who processes claims for services provided by a physician or health care provider.
Medical Transcription - The conversion of handwritten or voice- recorded medical information. The records can be paper or electronic. Medicaid - Considered the nation's primary health safety net for low- income people and families. Medicare - Provides health coverage for younger people with certain disabilities and people over the age of 6. Outpatient - A person who receives medical treatment without admittance to a hospital for 2. PPO - Preferred provider organization.
Allows a patient to use any doctor or hospital within the network to provide health care at reduced rates to the insurer's or administrator's clients. Premium - The amount that the insured or their employer pays for health insurance coverage.
WHO - The World Health Organization directs and coordinates health care initiatives within the United Nations. It helps set standards for global research norms, provides technical support to countries and assesses world health trends.
Medical Billing Terms - Comprehensive Glossary. A comprehensive collection of Medical Billing Terms and acronyms used by the Medical Insurance Specialist and coder. Here we've compiled a glossary of terms and acronyms commonly used in the healthcare reimbursement process. If you. don't see what you're looking for or have a suggestion, please let us know here. Terms are organized alphabetically.
Just click on the. F thru KL thru RS thru Z5. Version 5. 01. 0 of the X1.
HIPAA transaction and code set standards for electronic healthcare transactions. This standard includes transactions for claims, referrals, claim status, eligibility, and remittances. Mandatory compliance date was January 1, 2. These standards are necessary for the new ICD- 1.
CM diagnosis codes. ACA - Affordable Care Act. Also referred to as "Obama. Care". A Federal law enacted in 2. It also expands Medicaid eligibility and guarantees coverage without regard to pre- existing medical conditions. Accept Assignment - When a healthcare provider accepts as full payment the amount paid on a claim by the insurance company. This excludes patient responsible amounts such as coinsurance or copay.
Adjusted Claim - When a claim is corrected which results in a credit or payment to the provider. Allowed Amount - The reimbursement amount an insurance company will pay for a healthcare procedure. This amount varies depending on the patients insurance plan. For 8. 0/2. 0 insurance, the provider accepts 8. AMA - American Medical Association. The AMA is the. largest association of doctors in the United States.
They publish the. Journal of American Medical Association which is one of the most widely. Aging - One of the medical billing terms referring. Most medical billing software's have the ability to generate a.
These reports. typically list balances by 3. Ancillary Services. These are typically services a patient requires in a hospital setting.
Appeal - . When an insurance plan does not pay for treatment, an appeal (either by. The. insurer may require documentation when processing an appeal and. Many times the process and associated forms can be found on the. Applied to Deductible (ATD).
You typically see these medical billing terms on the patient. This is the amount of the charges, determined by the patients. Many plans have a.
Assignment of Benefits(AOB) - Insurance payments that are paid directly to the doctor or hospital for a patients treatment. This is designated in Box 2. CMS- 1. 50. 0 claim form.
ASP. - Application Service Provider. This is a computer based services over a.
Sometimes referred to as Saa. S. (Software as a Service). There application service providers that offer.
Medical Billing. The appeal of an ASP is it frees a business of the the. Authorization - When a patient requires permission (or authorization) from the insurance company before receiving certain treatments or services. Beneficiary - Person or persons covered by the health insurance plan and eligible to receive benefits. Medical Billing Terms - Medical Billing Glossary. Blue Cross Blue Shield (BCBS).
An organization of affiliated insurance companies (approximately. Blue Cross or Blue Shield). Many local BCBS. associations are non- profit BCBS sometimes acts as administrators of.
Medicare in many states or regions. Capitation. - A fixed payment paid per patient enrolled over a defined period of. This covers the costs. This payment is not.
Carrier - Simply the insurance company or "carrier" the patient has a contract with to provide health insurance. Category I Codes - Codes for medical procedures or services identified by the 5 digit CPT Code. Category II Codes - Optional performance measurement tracking codes which are numeric with a letter as the last digit (example: 9.
B). Category III Codes - Temporary codes assigned for collecting data which are numeric followed by a letter in the last digit (example: 5. U). CHAMPUS. - Civilian Health and Medical Program of the Uniformed Services. Recently renamed TRICARE. This is federal health insurance for active. National Guard and Reserve, retirees, their families, and. Charity Care - When medical care is provided at no cost or at reduced cost to a patient that cannot afford to pay. Clean Claim. - Medical billing term for a complete submitted insurance claim that.
Clearinghouse. - This is a service that transmits claims to insurance carriers. Prior. to submitting claims the clearinghouse scrubs claims and checks for. This minimizes the amount of rejected claims as most errors can. Clearinghouses electronically transmit claim. HIPPA standards (this is. CMS. - Centers for Medicaid and Medicare Services.
Federal agency which. Medicare, Medicaid, HIPPA, and other health programs. Formerly known as the HCFA (Health Care Financing Administration). You'll notice that CMS it the source of a lot of medical billing terms. CMS 1. 50. 0. - Medical claim form established by CMS to submit paper claims to. Medicare and Medicaid. Most commercial insurance carriers also require.
CMS- 1. 50. 0's. The form is distinguished by. Coding - Medical Billing Coding. ICD- 9 or ICD- 1. CPT codes. This is for the purpose of reimbursing the provider and classifying diseases and treatments. COBRA Insurance. - This is health insurance coverage available to an individual and. Because it does not typically receive company matching, It's. Employers must. extend COBRA coverage to employees dismissed for a.
COBRA stands for. Consolidated Omnibus Budget Reconciliation Act which was passed by. Congress in 1. 98. COBRA coverage typically lasts up to 1. Co- Insurance. - Percentage or amount defined in the insurance plan for which the. Most plans have a ratio of 9. For example the insurance carrier pays 8.
Collection Ratio - This is in reference. It's the ratio of the payments. Contractual Adjustment.
The amount of charges a provider or hospital agrees to write off and. Coordination of Benefits (COB) - When a. One insurance. carrier is designated as the primary carrier and the other as secondary.
Co- Pay - Amount paid by patient at each visit as defined by the insured plan. CPT Code. - Current Procedural Terminology. This is a 5 digit code assigned for. The CPT has a. corresponding ICD- 9 diagnosis code. Established by the American Medical. Association. This is one of the medical billing terms we use a lot. Credentialing. - This is an application process for a provider to participate with an.
Many carriers now request credentialing through CAQH. The. CAQH credentialing process is a universal system now accepted by. Credit Balance - The. Balance" or "Amount Due" column of your. It may also be shown in parenthesis; ($5. The provider may owe the. Crossover claim - When claim information is automatically sent from Medicare the secondary insurance such as Medicaid.
Date of Service (DOS) - Date that health care services were provided. Day Sheet - Summary of daily patient treatments, charges, and payments received. Deductible. - amount patient must pay before insurance coverage begins. For. example, a patient could have a $1. This could take several doctor's. Demographics - Physical characteristics of a patient such as age, sex, address, etc.
DME - Durable Medical Equipment - Medical supplies such as wheelchairs, oxygen, catheter, glucose monitors, crutches, walkers, etc. DOB - Abbreviation for Date of Birth. Downcoding. - When the insurance company reduces the code (and corresponding. The insurers computer processing. Duplicate Coverage Inquiry (DCI).
Request by an insurance company or group medical plan by another. Dx - Abbreviation for diagnosis code (ICD- 9 or ICD- 1. Electronic Claim. Claim information is sent electronically from the billing software to. The claim file. must be in a standard electronic format as defined by the receiver. Electronic Funds Transfer (EFT). An electronic paperless means of transferring money.
This allows. funds to be transferred, credited, or debited to a bank account and. E/M - . Medical billing terms for the Evaluation and Management section of the CPT codes. These are the CPT. EMR - Electronic Medical Records. Also referred to as EHR (Electronic Health Records). This is a medical. An EMR is the patient's medical record managed at the providers.
The EHR is a comprehensive collection of the patients medical. Encryption - Conversion of data into a form that cannot be easily seen by someone who is not authorized. Encrypted emails may be used when sending patient info to comply with HIPAA requirements for protection of patient information. Enrollee - Individual covered by health insurance.
EOB. - Explanation of Benefits. One of the medical billing terms for the. ERA - . Electronic Remittance Advice.
This is an electronic version of an. EOB that provides details of insurance claim payments. These. are formatted in according to the HIPAA X1. N 8. 35 standard. ERISA - Employee Retirement Income Security Act of.
This law established the reporting, disclosure of grievances, and. Self- insured plans are regulated by this law. Errors and Omissions Insurance - Liability insurance for professionals to cover mistakes which may cause financial harm to another part. Medical Billing Terms. F thru KL thru RS thru ZMedical Billing Terms - Medical Billing Glossary. Medical Billing Terms A thru EReturn from Medical Billing Terms to All- Things- Medical- Billing. Copyright 2. 01. 5 All- Things- Medical- Billing.