Do you know about - medical Billing Terms and medical Coding Terminology
Low Cost Health Insurance! Again, for I know. Ready to share new things that are useful. You and your friends.Those in curative billing and coding careers have a terminology of unique terms and abbreviations. Below are some of the more oftentimes used curative Billing terms and acronyms. Also included is some curative coding terminology.
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Aging - Refers to the unpaid assurance claims or patient balances that are due past 30 days. Most curative billing software's have the ability to create a isolate record for assurance aging and patient aging. These reports typically list balances by 30, 60, 90, and 120 day increments.
Appeal - When an assurance 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 need added documentation.
Applied to Deductible - Typically seen on the patient statement. This is the amount of the charges, determined by the patients assurance plan, the patient owes the provider. Many plans have a maximum yearly deductible that once met is then covered by the assurance provider.
Assignment of Benefits - assurance payments that are paid to the physician or hospital for a patients treatment.
Beneficiary - man or persons covered by the health assurance plan.
Clearinghouse - This is a assistance that transmits claims to assurance carriers. Prior to submitting claims the clearinghouse scrubs claims and checks for errors. This minimizes the amount of rejected claims as most errors can be categorically corrected. Clearinghouses electronically send claim information that is compliant with the accurate Hippa standards (this is one of the curative billing terms we see a lot more of lately).
Cms - Centers for Medicaid and Medicare Services. Federal division which administers Medicare, Medicaid, Hippa, and other health programs. Once known as the Hcfa (Health Care Financing Administration). You'll notice that Cms it the source of a lot of curative billing terms.
Cms 1500 - curative claim form established by Cms to submit paper claims to Medicare and Medicaid. Most industrial assurance carriers also need paper claims be submitted on Cms-1500's. The form is distinguished by it's red ink.
Coding -Medical Billing Coding involves taking the doctors notes from a patient visit and translating them into the permissible Icd-9 code for determination and Cpt codes for treatment.
Co-Insurance - ration or amount defined in the assurance plan for which the patient is responsible. Most plans have a ratio of 90/10 or 80/20, 70/30, etc. For example the assurance carrier pays 80% and the patient pays 20%.
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 reporting a policy performed by the physician. The Cpt has a corresponding Icd-9 determination code. Established by the American curative Association. This is one of the curative billing terms we use a lot.
Date of assistance (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 assurance coverage begins. For example, a patient could have a 00 deductible per year before their health assurance will begin paying. This could take several doctor's visits or prescriptions to reach the deductible.
Demographics - bodily characteristics of a patient such as age, sex, address, etc. Indispensable for filing a claim.
Dme - Durable curative equipment - curative supplies such as wheelchairs, oxygen, catheter, glucose monitors, crutches, walkers, etc.
Dob - Abbreviation for Date of Birth
Dx - Abbreviation for determination code (Icd-9-Cm).
Electronic Claim - Claim information is sent electronically from the billing software to the clearinghouse or directly to the assurance carrier. The claim file must be in a proper electronic format as defined by the receiver.
E/M - estimation and administration section of the Cpt codes. These are the Cpt codes 99201 thru 99499 most used by physicians to passage (or evaluate) a patients rehabilitation needs.
Emr - Electronic curative Records. curative records in digital format of a patients hospital or supplier treatment.
Eob - Explanation of Benefits. One of the curative billing terms for the statement that comes with the assurance business payment to the supplier explaining payment details, covered charges, write offs, and patient responsibilities and deductibles.
Era - Electronic Remittance Advice. This is an electronic version of an assurance Eob that provides details of assurance claim payments. These are formatted in according to the Hipaa X12N 835 standard.
Fee program - Cost related with each rehabilitation Cpt curative billing codes.
Fraud - When a supplier receives payment or a patient obtains services by deliberate, dishonest, or misleading means.
Guarantor - A responsible party and/or insured party who is not a patient.
Hcpcs - health Care Financing administration base policy Coding System. (pronounced "hick-picks"). This is a three level law of codes. Cpt is Level I. A standardized curative coding law used to report exact items or services in case,granted when delivering health services. May also be referred to as a policy code in the curative billing glossary.
The three Hcpcs levels are:
Level I - American curative Associations Current Procedural Terminology (Cpt) codes.
Level Ii - The alphanumeric codes which include mostly non-physician items or services such as curative 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 secret insurers for exact areas or programs.
Hipaa - health assurance Portability and responsibility Act. several federal regulations intended to enhance the efficiency and effectiveness of health care. Hipaa has introduced a lot of new curative billing terms into our vocabulary lately.
Hmo - health Maintenance Organization. A type of health 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 patient diagnosis. This is a 3 to 5 digit number.
Icd 10 Code - 10th revision of the International Classification of Diseases. Uses 3 to 7 digit. Includes added digits to allow more ready codes. The U.S. division of health 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 amount the insured is responsible for paying for eligible health plan expenses. When this maximum limit is reached, the assurance typically then pays 100% of eligible expenses.
Medical Assistant - Performs executive and clinical duties to retain a health care supplier such as a physician, physicians assistant, nurse, or nurse practitioner.
Medical Coder - Analyzes patient charts and assigns the accurate Icd-9 determination codes (soon to be Icd-10) and corresponding Cpt rehabilitation codes and any related Cpt modifiers.
Medical Billing specialist - The man who processes assurance claims and patient payments of services performed by a physician or other health care supplier and vital to the financial execution of a practice. Makes sure curative billing codes and assurance information are entered correctly and submitted to assurance payer. Enters assurance payment information and processes patient statements and payments.
Medical Necessity - curative assistance or policy performed for rehabilitation of an illness or injury not determined investigational, cosmetic, or experimental.
Medical Transcription - The conversion of voice recorded or hand written curative information dictated by health care professionals (such as physicians) into text format records. These records can be either electronic or paper.
Medicare - assurance in case,granted by federal government for population over 65 or population under 65 with confident restrictions. Medicare has 2 parts; Medicare Part A for hospital coverage and Part B for doctors office or patient care.
Medicare Donut Hole - The gap or dissimilarity between the initial limits of assurance and the catastrophic Medicare Part D coverage limits for designate drugs.
Medicaid - assurance coverage for low earnings patients. Funded by Federal and state government and administered by states.
Modifier - Modifier to a Cpt rehabilitation code that supply added information to assurance payers for procedures or services that have been altered or "modified" in some way. Modifiers are important to by comparison added procedures and gather repayment for them.
Network supplier - health care supplier who is contracted with an assurance supplier to supply care at a negotiated cost.
Npi amount - National supplier Identifier. A unique 10 digit identification amount required by Hipaa and assigned through the National Plan and supplier Enumeration law (Nppes).
Out-of Network (or Non-Participating) - A supplier that does not have a contract with the assurance carrier. Patients ordinarily 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 amount the patient is responsible to pay under their insurance. Charges above this limit are the assurance companies obligation. These Out-of-pocket maximums can apply to all coverage or to a exact advantage class such as prescriptions.
Outpatient - Typically rehabilitation in a physicians office, clinic, or day surgery premise continuing less than one day.
Patient responsibility - The amount a patient is responsible for paying that is not covered by the assurance plan.
Pcp - original Care physician - ordinarily the physician who provides initial care and coordinates added care if necessary.
Ppo - favorite supplier Organization. assurance plan that allows the patient to take a physician 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 assurance plan for original care physician to wise up the patient assurance carrier of confident curative procedures (such as patient surgery) for those procedures to be determined a covered expense.
Premium - The amount the insured or their boss pays (usually monthly) to the health assurance business for coverage.
Provider - physician or curative care premise (hospital) that provides health care services.
Referral - When a supplier (typically the original Care Physician) refers a patient to other supplier (usually a specialist).
Self Pay - payment made at the time of assistance by the patient.
Secondary assurance Claim - assurance claim for coverage paid after original assurance makes payment. Typically intended to cover gaps in assurance coverage.
Sof - Signature on File.
Superbill - One of the curative billing terms for the form the supplier uses to document the rehabilitation and determination for a patient visit. Typically includes several generally used Icd-9 determination and Cpt procedural codes. One of the most oftentimes used curative billing terms.
Supplemental assurance - added assurance policy that covers claims fro deductibles and coinsurance. oftentimes used to cover these expenses not covered by Medicare.
Taxonomy Code - Code for the supplier specialty sometimes required to process a claim.
Tertiary assurance - assurance paid in addition to original and secondary insurance. Tertiary assurance covers costs the original and secondary assurance may not cover.
Tin - Tax Identification Number. Also known as boss Identification amount (Ein).
Tos - Type of Service. record of the class of assistance performed.
Ub04 - Claim form for hospitals, clinics, or any supplier billing for premise fees similar to Cms 1500. Replaces the Ub92 form.
Unbundling - Submitting more than one Cpt rehabilitation code when only one is appropriate.
Upin - Unique physician Identification Number. 6 digit physician identification amount created by Cms. Discontinued in 2007 and replaced by Npi number.
Write-off (W/O) - The dissimilarity between what the supplier charges for a policy or rehabilitation and what the assurance plan allows. The patient 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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