Do you know about - healing Billing Terms and healing Coding Terminology
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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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Aging - Refers to the unpaid assurance claims or inpatient balances that are due past 30 days. Most healing billing software's have the potential to generate a detach narrative for assurance aging and inpatient 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 provider or patient) is the process of formally objecting this judgment. The insurer may want added documentation.
Applied to Deductible - Typically seen on the inpatient statement. This is the number of the charges, thought about by the patients assurance plan, the inpatient owes the provider. Many plans have a maximum annual deductible that once met is then covered by the assurance provider.
Assignment of Benefits - assurance payments that are paid to the doctor or hospital for a patients treatment.
Beneficiary - someone or persons covered by the health assurance plan.
Clearinghouse - This is a aid that transmits claims to assurance 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 nothing else but corrected. Clearinghouses electronically send claim information that is compliant with the exact 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 agency which administers Medicare, Medicaid, Hippa, and other health programs. Formerly 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 market assurance carriers also want paper claims be submitted on Cms-1500's. The form is remarkable 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 determination and Cpt codes for treatment.
Co-Insurance - division or number defined in the assurance plan for which the inpatient 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 inpatient pays 20%.
Co-Pay - number 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 policy performed by the physician. The Cpt has a corresponding Icd-9 determination code. Established by the American healing Association. This is one of the healing billing terms we use a lot.
Date of aid (Dos) - Date that health care services were provided.
Day Sheet - summary of daily inpatient treatments, charges, and payments received.
Deductible - number inpatient must pay before assurance coverage begins. For example, a inpatient 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 - corporal characteristics of a inpatient such as age, sex, address, etc. Primary for filing a claim.
Dme - Durable healing equipment - healing 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 standard electronic format as defined by the receiver.
E/M - estimation and supervision section of the Cpt codes. These are the Cpt codes 99201 thru 99499 most used by physicians to entrance (or evaluate) a patients medicine 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 assurance enterprise 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 assurance Eob that provides details of assurance claim payments. These are formatted in agreeing to the Hipaa X12N 835 standard.
Fee agenda - Cost connected with each medicine 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 supervision base policy Coding System. (pronounced "hick-picks"). This is a three level law of codes. Cpt is Level I. A standardized healing coding law used to recap specific items or services in case,granted when delivering health services. May also be referred to as a policy 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 include 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 private insurers for specific 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 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 revision of the International Classification of Diseases. Uses 3 to 7 digit. Includes added digits to allow more available codes. The U.S. agency 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 number 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 administrative and clinical duties to support a health care provider such as a physician, physicians assistant, nurse, or nurse practitioner.
Medical Coder - Analyzes inpatient charts and assigns the exact Icd-9 determination codes (soon to be Icd-10) and corresponding Cpt medicine codes and any connected Cpt modifiers.
Medical Billing scholar - The someone who processes assurance 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 assurance information are entered correctly and submitted to assurance payer. Enters assurance cost information and processes inpatient statements and payments.
Medical Necessity - healing aid or policy performed for medicine of an illness or injury not thought about 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 either electronic or paper.
Medicare - assurance in case,granted by federal government for population over 65 or population under 65 with determined 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 inequity in the middle of the preliminary limits of assurance and the catastrophic Medicare Part D coverage limits for prescription drugs.
Medicaid - assurance coverage for low wage patients. Funded by Federal and state government and administered by states.
Modifier - Modifier to a Cpt medicine code that provide added information to assurance payers for procedures or services that have been altered or "modified" in some way. Modifiers are important to construe added procedures and acquire repayment for them.
Network provider - health care provider who is contracted with an assurance provider to provide care at a negotiated cost.
Npi number - National provider Identifier. A unique 10 digit identification number 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 ageement with the assurance carrier. Patients ordinarily 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 number the inpatient is responsible to pay under their insurance. Charges above this limit are the assurance associates obligation. These Out-of-pocket maximums can apply to all coverage or to a specific benefit type such as prescriptions.
Outpatient - Typically medicine in a physicians office, clinic, or day surgery premise chronic less than one day.
Patient responsibility - The number a inpatient is responsible for paying that is not covered by the assurance plan.
Pcp - original Care doctor - ordinarily the doctor who provides preliminary care and coordinates added care if necessary.
Ppo - favorite provider Organization. assurance plan that allows the inpatient to agree a doctor or hospital within the network. Similar to an Hmo.
Practice supervision 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 doctor to tip off the inpatient assurance carrier of determined healing procedures (such as inpatient surgery) for those procedures to be thought about a covered expense.
Premium - The number the insured or their employer pays (usually monthly) to the health assurance enterprise for coverage.
Provider - doctor or healing care premise (hospital) that provides health care services.
Referral - When a provider (typically the original Care Physician) refers a inpatient to someone else provider (usually a specialist).
Self Pay - cost made at the time of aid 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 healing billing terms for the form the provider uses to document the medicine and determination for a inpatient visit. Typically includes several generally used Icd-9 determination and Cpt procedural codes. One of the most frequently used healing billing terms.
Supplemental assurance - added assurance policy 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 assurance - assurance paid in increasing to original and secondary insurance. Tertiary assurance covers costs the original and secondary assurance may not cover.
Tin - Tax Identification Number. Also known as employer Identification number (Ein).
Tos - Type of Service. narrative of the type of aid performed.
Ub04 - Claim form for hospitals, clinics, or any provider billing for premise 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 substituted by Npi number.
Write-off (W/O) - The inequity in the middle of what the provider charges for a policy or medicine and what the assurance 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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