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Those in healing billing and coding careers have a terminology of unique terms and abbreviations. Below are some of the more frequently used healing Billing terms and acronyms. Also included is some healing coding terminology.
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Medical Billing And Coding Online
Aging - Refers to the unpaid guarnatee claims or inpatient balances that are due past 30 days. Most healing billing software's have the capability to generate a cut off description for guarnatee aging and inpatient 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 provider or patient) is the process of formally objecting this judgment. The insurer may need added documentation. Applied to Deductible - Typically seen on the inpatient statement. This is the amount of the charges, carefully by the patients guarnatee plan, the inpatient owes the provider. Many plans have a maximum every year 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 health guarnatee plan. Clearinghouse - This is a service that transmits claims to guarnatee 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 precisely corrected. Clearinghouses electronically forward claim information that is compliant with the definite Hippa standards (this is one of the healing 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 health programs. Once known as the Hcfa (Health Care Financing Administration). You'll observation that Cms it the source of a lot of healing billing terms. Cms 1500 - healing claim form established by Cms to submit paper claims to Medicare and Medicaid. Most industrial guarnatee carriers also need paper claims be submitted on Cms-1500's. The form is excellent by it's red ink. Coding -Medical Billing Coding involves taking the doctors notes from a inpatient visit and translating them into the proper Icd-9 code for prognosis and Cpt codes for treatment. Co-Insurance - percentage or amount defined in the guarnatee plan for which the inpatient 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 inpatient pays 20%. Co-Pay - amount paid by inpatient 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 prognosis code. Established by the American healing Association. This is one of the healing billing terms we use a lot. Date of service (Dos) - Date that health care services were provided. Day Sheet - summary of daily inpatient treatments, charges, and payments received. Deductible - amount inpatient must pay before guarnatee coverage begins. For example, a inpatient could have a 00 deductible per year before their health guarnatee will begin paying. This could take several doctor's visits or prescriptions to reach the deductible. Demographics - corporeal characteristics of a inpatient such as age, sex, address, etc. Needful for filing a claim. Dme - Durable healing tool - healing supplies such as wheelchairs, oxygen, catheter, glucose monitors, crutches, walkers, etc. Dob - Abbreviation for Date of Birth Dx - Abbreviation for prognosis 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 proper electronic format as defined by the receiver. E/M - evaluation 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 treatment needs. Emr - Electronic healing Records. healing records in digital format of a patients hospital or provider treatment. Eob - Explanation of Benefits. One of the healing billing terms for the statement that comes with the guarnatee company cost to the provider explaining cost details, covered charges, write offs, and inpatient 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 agreeing to the Hipaa X12N 835 standard. Fee schedule - Cost linked with each treatment Cpt healing billing codes. Fraud - When a provider receives cost or a inpatient 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 tasteless procedure Coding System. (pronounced "hick-picks"). This is a three level law of codes. Cpt is Level I. A standardized healing coding law used to relate exact items or services in case,granted when delivering health services. May also be referred to as a procedure code in the healing billing glossary. The three Hcpcs levels are: Level I - American healing Associations Current Procedural Terminology (Cpt) codes. Level Ii - The alphanumeric codes which consist of mostly non-physician items or services such as healing 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 underground insurers for exact areas or programs. Hipaa - health guarnatee Portability and accountability Act. several federal regulations intended to enhance the efficiency and effectiveness of health care. Hipaa has introduced a lot of new healing 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 inpatient diagnosis. This is a 3 to 5 digit number. Icd 10 Code - 10th improvement of the International Classification of Diseases. Uses 3 to 7 digit. Includes added digits to allow more ready codes. The U.S. branch 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 guarnatee typically then pays 100% of eligible expenses. Medical Assistant - Performs executive and clinical duties to withhold a health care provider such as a physician, physicians assistant, nurse, or nurse practitioner. Medical Coder - Analyzes inpatient charts and assigns the definite Icd-9 prognosis codes (soon to be Icd-10) and corresponding Cpt treatment codes and any linked Cpt modifiers. Medical Billing master - The man who processes guarnatee claims and inpatient payments of services performed by a doctor or other health care provider and vital to the financial doing of a practice. Makes sure healing billing codes and guarnatee information are entered correctly and submitted to guarnatee payer. Enters guarnatee cost information and processes inpatient statements and payments. Medical Necessity - healing service or procedure performed for treatment of an illness or injury not carefully investigational, cosmetic, or experimental. Medical Transcription - The conversion of voice recorded or hand written healing information dictated by health care professionals (such as physicians) into text format records. These records can be whether electronic or paper. Medicare - guarnatee in case,granted by federal government for habitancy over 65 or habitancy under 65 with sure restrictions. Medicare has 2 parts; Medicare Part A for hospital coverage and Part B for doctors office or inpatient care. Medicare Donut Hole - The gap or divergence 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 revenue patients. Funded by Federal and state government and administered by states. Modifier - Modifier to a Cpt treatment code that contribute added information to guarnatee payers for procedures or services that have been altered or "modified" in some way. Modifiers are leading to elaborate added procedures and derive repayment for them. Network provider - health care provider who is contracted with an guarnatee provider to contribute care at a negotiated cost. Npi amount - National provider Identifier. A unique 10 digit identification amount required by Hipaa and assigned through the National Plan and provider Enumeration law (Nppes). Out-of Network (or Non-Participating) - A provider that does not have a contract with the guarnatee carrier. Patients regularly responsible for a greater measure 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 inpatient is responsible to pay under their insurance. Charges above this limit are the guarnatee fellowships obligation. These Out-of-pocket maximums can apply to all coverage or to a exact benefit category such as prescriptions. Outpatient - Typically treatment in a physicians office, clinic, or day surgical operation facility persisting less than one day. Patient accountability - The amount a inpatient is responsible for paying that is not covered by the guarnatee plan. Pcp - original Care doctor - regularly the doctor who provides initial care and coordinates added care if necessary. Ppo - adored provider Organization. guarnatee plan that allows the inpatient to agree 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 original care doctor to fill in the inpatient guarnatee carrier of sure healing procedures (such as inpatient surgery) for those procedures to be carefully a covered expense. Premium - The amount the insured or their employer pays (usually monthly) to the health guarnatee company for coverage. Provider - doctor or healing care facility (hospital) that provides health care services. Referral - When a provider (typically the original Care Physician) refers a inpatient to an additional one provider (usually a specialist). Self Pay - cost made at the time of service by the patient. Secondary guarnatee Claim - guarnatee claim for coverage paid after original guarnatee makes payment. Typically intended to cover gaps in guarnatee coverage. Sof - Signature on File. Superbill - One of the healing billing terms for the form the provider uses to document the treatment and prognosis for a inpatient visit. Typically includes several ordinarily used Icd-9 prognosis and Cpt procedural codes. One of the most frequently used healing billing terms. Supplemental guarnatee - added guarnatee procedure that covers claims fro deductibles and coinsurance. frequently used to cover these expenses not covered by Medicare. Taxonomy Code - Code for the provider specialty sometimes required to process a claim. Tertiary guarnatee - guarnatee paid in increasing to original and secondary insurance. Tertiary guarnatee covers costs the original and secondary guarnatee may not cover. Tin - Tax Identification Number. Also known as employer Identification amount (Ein). Tos - Type of Service. description of the category of service performed. Ub04 - Claim form for hospitals, clinics, or any provider billing for facility fees similar to Cms 1500. Replaces the Ub92 form. Unbundling - Submitting more than one Cpt treatment code when only one is appropriate. Upin - Unique doctor Identification Number. 6 digit doctor identification amount created by Cms. Discontinued in 2007 and substituted by Npi number. Write-off (W/O) - The divergence in the middle of what the provider charges for a procedure or treatment and what the guarnatee plan allows. The inpatient 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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