Do you know about - curative Billing Terms and curative Coding Terminology
Health Insurance Companies! Again, for I know. Ready to share new things that are useful. You and your friends.Those in medical billing and coding careers have a terminology of unique terms and abbreviations. Below are some of the more often used medical Billing terms and acronyms. Also included is some medical coding terminology.
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Aging - Refers to the unpaid guarnatee claims or outpatient balances that are due past 30 days. Most medical billing software's have the ability to create a isolate record for guarnatee aging and outpatient aging. These reports typically list balances by 30, 60, 90, and 120 day increments.
Appeal - When an guarnatee plan does not pay for treatment, an appeal (either by the supplier or patient) is the process of formally objecting this judgment. The insurer may require supplementary documentation.
Applied to Deductible - Typically seen on the outpatient statement. This is the number of the charges, carefully by the patients guarnatee plan, the outpatient owes the provider. Many plans have a maximum annual deductible that once met is then covered by the guarnatee provider.
Assignment of Benefits - guarnatee payments that are paid to the doctor or hospital for a patients treatment.
Beneficiary - man or persons covered by the condition guarnatee plan.
Clearinghouse - This is a aid that transmits claims to guarnatee carriers. Prior to submitting claims the clearinghouse scrubs claims and checks for errors. This minimizes the number of rejected claims as most errors can be undoubtedly corrected. Clearinghouses electronically transmit claim information that is compliant with the precise Hippa standards (this is one of the medical billing terms we see a lot more of lately).
Cms - Centers for Medicaid and Medicare Services. Federal branch which administers Medicare, Medicaid, Hippa, and other condition programs. Formerly known as the Hcfa (Health Care Financing Administration). You'll consideration that Cms it the source of a lot of medical billing terms.
Cms 1500 - medical claim form established by Cms to submit paper claims to Medicare and Medicaid. Most industrial guarnatee carriers also require paper claims be submitted on Cms-1500's. The form is considerable by it's red ink.
Coding -Medical Billing Coding involves taking the doctors notes from a outpatient visit and translating them into the permissible Icd-9 code for pathology and Cpt codes for treatment.
Co-Insurance - division or number defined in the guarnatee plan for which the outpatient is responsible. Most plans have a ratio of 90/10 or 80/20, 70/30, etc. For example the guarnatee carrier pays 80% and the outpatient pays 20%.
Co-Pay - number paid by outpatient at each visit as defined by the insured plan.
Cpt Code - Current Procedural Terminology. This is a 5 digit code assigned for reporting a procedure performed by the physician. The Cpt has a corresponding Icd-9 pathology code. Established by the American medical Association. This is one of the medical billing terms we use a lot.
Date of aid (Dos) - Date that condition care services were provided.
Day Sheet - overview of daily outpatient treatments, charges, and payments received.
Deductible - number outpatient must pay before guarnatee coverage begins. For example, a outpatient could have a 00 deductible per year before their condition guarnatee will begin paying. This could take any doctor's visits or prescriptions to reach the deductible.
Demographics - corporeal characteristics of a outpatient such as age, sex, address, etc. Important for filing a claim.
Dme - Durable medical tool - medical supplies such as wheelchairs, oxygen, catheter, glucose monitors, crutches, walkers, etc.
Dob - Abbreviation for Date of Birth
Dx - Abbreviation for pathology code (Icd-9-Cm).
Electronic Claim - Claim information is sent electronically from the billing software to the clearinghouse or directly to the guarnatee carrier. The claim file must be in a thorough electronic format as defined by the receiver.
E/M - appraisal and administration section of the Cpt codes. These are the Cpt codes 99201 thru 99499 most used by physicians to way (or evaluate) a patients medicine needs.
Emr - Electronic medical Records. medical records in digital format of a patients hospital or supplier treatment.
Eob - Explanation of Benefits. One of the medical billing terms for the statement that comes with the guarnatee enterprise payment to the supplier explaining payment details, covered charges, write offs, and outpatient responsibilities and deductibles.
Era - Electronic Remittance Advice. This is an electronic version of an guarnatee Eob that provides details of guarnatee claim payments. These are formatted in according to the Hipaa X12N 835 standard.
Fee agenda - Cost connected with each medicine Cpt medical billing codes.
Fraud - When a supplier receives payment or a outpatient obtains services by deliberate, dishonest, or misleading means.
Guarantor - A responsible party and/or insured party who is not a patient.
Hcpcs - condition Care Financing administration tasteless procedure Coding System. (pronounced "hick-picks"). This is a three level law of codes. Cpt is Level I. A standardized medical coding law used to report specific items or services provided when delivering condition services. May also be referred to as a procedure code in the medical billing glossary.
The three Hcpcs levels are:
Level I - American medical Associations Current Procedural Terminology (Cpt) codes.
Level Ii - The alphanumeric codes which include mostly non-physician items or services such as medical supplies, ambulatory services, prosthesis, etc. These are items and services not covered by Cpt (Level I) procedures.
Level Iii - Local codes used by state Medicaid organizations, Medicare contractors, and hidden insurers for specific areas or programs.
Hipaa - condition guarnatee Portability and accountability Act. any federal regulations intended to enhance the efficiency and effectiveness of condition care. Hipaa has introduced a lot of new medical billing terms into our vocabulary lately.
Hmo - condition Maintenance Organization. A type of condition care plan that places restrictions on treatments.
Icd-9 Code - Also know as Icd-9-Cm. International Classification of Diseases classification law used to assign codes to outpatient diagnosis. This is a 3 to 5 digit number.
Icd 10 Code - 10th correction of the International Classification of Diseases. Uses 3 to 7 digit. Includes supplementary digits to allow more available codes. The U.S. branch of condition and Human Services has set an implementation deadline of October, 2013 for Icd-10.
Inpatient - Hospital stay longer than one day (24 hours).
Maximum Out of Pocket - The maximum number the insured is responsible for paying for eligible condition plan expenses. When this maximum limit is reached, the guarnatee typically then pays 100% of eligible expenses.
Medical Assistant - Performs menagerial and clinical duties to reserve a condition care supplier such as a physician, physicians assistant, nurse, or nurse practitioner.
Medical Coder - Analyzes outpatient charts and assigns the precise Icd-9 pathology codes (soon to be Icd-10) and corresponding Cpt medicine codes and any connected Cpt modifiers.
Medical Billing expert - The man who processes guarnatee claims and outpatient payments of services performed by a doctor or other condition care supplier and vital to the financial operation of a practice. Makes sure medical billing codes and guarnatee information are entered correctly and submitted to guarnatee payer. Enters guarnatee payment information and processes outpatient statements and payments.
Medical Necessity - medical aid or procedure performed for medicine of an illness or injury not carefully investigational, cosmetic, or experimental.
Medical Transcription - The conversion of voice recorded or hand written medical information dictated by condition care professionals (such as physicians) into text format records. These records can be whether electronic or paper.
Medicare - guarnatee provided by federal government for people over 65 or people under 65 with sure restrictions. Medicare has 2 parts; Medicare Part A for hospital coverage and Part B for doctors office or outpatient care.
Medicare Donut Hole - The gap or contrast in the middle of the initial limits of guarnatee and the catastrophic Medicare Part D coverage limits for prescribe drugs.
Medicaid - guarnatee coverage for low earnings patients. Funded by Federal and state government and administered by states.
Modifier - Modifier to a Cpt medicine code that furnish supplementary information to guarnatee payers for procedures or services that have been altered or "modified" in some way. Modifiers are foremost to explicate supplementary procedures and secure reimbursement for them.
Network supplier - condition care supplier who is contracted with an guarnatee supplier to furnish care at a negotiated cost.
Npi number - National supplier Identifier. A unique 10 digit identification number required by Hipaa and assigned straight through the National Plan and supplier Enumeration law (Nppes).
Out-of Network (or Non-Participating) - A supplier that does not have a compact with the guarnatee carrier. Patients regularly responsible for a greater part of the charges or may have to pay all the charges for using an out-of network provider.
Out-Of-Pocket Maximum - The maximum number the outpatient is responsible to pay under their insurance. Charges above this limit are the guarnatee clubs obligation. These Out-of-pocket maximums can apply to all coverage or to a specific benefit category such as prescriptions.
Outpatient - Typically medicine in a physicians office, clinic, or day surgical operation installation persisting less than one day.
Patient accountability - The number a outpatient is responsible for paying that is not covered by the guarnatee plan.
Pcp - customary Care doctor - regularly the doctor who provides initial care and coordinates supplementary care if necessary.
Ppo - beloved supplier Organization. guarnatee plan that allows the outpatient to select a doctor or hospital within the network. Similar to an Hmo.
Practice administration Software - software used for the daily operations of a providers office. Typically includes appointment scheduling and billing functions.
Preauthorization - Requirement of guarnatee plan for customary care doctor to edify the outpatient guarnatee carrier of sure medical procedures (such as outpatient surgery) for those procedures to be carefully a covered expense.
Premium - The number the insured or their manager pays (usually monthly) to the condition guarnatee enterprise for coverage.
Provider - doctor or medical care installation (hospital) that provides condition care services.
Referral - When a supplier (typically the customary Care Physician) refers a outpatient to another supplier (usually a specialist).
Self Pay - payment made at the time of aid by the patient.
Secondary guarnatee Claim - guarnatee claim for coverage paid after customary guarnatee makes payment. Typically intended to cover gaps in guarnatee coverage.
Sof - Signature on File.
Superbill - One of the medical billing terms for the form the supplier uses to document the medicine and pathology for a outpatient visit. Typically includes any generally used Icd-9 pathology and Cpt procedural codes. One of the most often used medical billing terms.
Supplemental guarnatee - supplementary guarnatee procedure that covers claims fro deductibles and coinsurance. often used to cover these expenses not covered by Medicare.
Taxonomy Code - Code for the supplier specialty sometimes required to process a claim.
Tertiary guarnatee - guarnatee paid in addition to customary and secondary insurance. Tertiary guarnatee covers costs the customary and secondary guarnatee may not cover.
Tin - Tax Identification Number. Also known as manager Identification number (Ein).
Tos - Type of Service. record of the category of aid performed.
Ub04 - Claim form for hospitals, clinics, or any supplier billing for installation fees similar to Cms 1500. Replaces the Ub92 form.
Unbundling - Submitting more than one Cpt medicine code when only one is appropriate.
Upin - Unique doctor Identification Number. 6 digit doctor identification number created by Cms. Discontinued in 2007 and supplanted by Npi number.
Write-off (W/O) - The contrast in the middle of what the supplier charges for a procedure or medicine and what the guarnatee plan allows. The outpatient is not responsible for the write off amount. May also be referred to as "not covered" in some glossary of billing terms.
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