medical Billing Terms and medical Coding Terminology

Health Insurance Claim Form 1500 Download - medical Billing Terms and medical Coding Terminology

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Those in curative billing and coding careers have a terminology of unique terms and abbreviations. Below are some of the more often used curative Billing terms and acronyms. Also included is some curative coding terminology.

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Health Insurance Claim Form 1500 Download

Aging - Refers to the unpaid insurance claims or sick person balances that are due past 30 days. Most curative billing software's have the capability to generate a isolate record for insurance aging and sick person aging. These reports typically list balances by 30, 60, 90, and 120 day increments.

Appeal - When an insurance 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 additional documentation.

Applied to Deductible - Typically seen on the sick person statement. This is the estimate of the charges, carefully by the patients insurance plan, the sick person owes the provider. Many plans have a maximum every year deductible that once met is then covered by the insurance provider.

Assignment of Benefits - insurance payments that are paid to the doctor or hospital for a patients treatment.

Beneficiary  - man or persons covered by the condition insurance plan.

Clearinghouse - This is a service that transmits claims to insurance carriers. Prior to submitting claims the clearinghouse scrubs claims and checks for errors. This minimizes the estimate of rejected claims as most errors can be unmistakably corrected. Clearinghouses electronically forward claim data that is compliant with the correct 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 group which administers Medicare, Medicaid, Hippa, and other condition programs. Once known as the Hcfa (Health Care Financing Administration). You'll consideration 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 commercial insurance carriers also want paper claims be submitted on Cms-1500's. The form is superior by it's red ink.

Coding -Medical Billing Coding involves taking the doctors notes from a sick person visit and translating them into the proper Icd-9 code for analysis and Cpt codes for treatment.

Co-Insurance - division or estimate defined in the insurance plan for which the sick person is responsible. Most plans have a ratio of 90/10 or 80/20, 70/30, etc. For example the insurance carrier pays 80% and the sick person pays 20%.

Co-Pay - estimate paid by sick person at each visit as defined by the insured plan.

Cpt Code - Current Procedural Terminology. This is a 5 digit code assigned for reporting a course performed by the physician. The Cpt has a corresponding Icd-9 analysis code. Established by the American curative Association. This is one of the curative billing terms we use a lot.

Date of service (Dos) - Date that condition care services were provided.

Day Sheet - overview of daily sick person treatments, charges, and payments received.

Deductible - estimate sick person must pay before insurance coverage begins. For example, a sick person could have a 00 deductible per year before their condition insurance will begin paying. This could take any doctor's visits or prescriptions to reach the deductible.

Demographics - bodily characteristics of a sick person such as age, sex, address, etc. Essential for filing a claim.

Dme - Durable curative tool - curative supplies such as wheelchairs, oxygen, catheter, glucose monitors, crutches, walkers, etc.

Dob - Abbreviation for Date of Birth

Dx - Abbreviation for analysis code (Icd-9-Cm).

Electronic Claim - Claim data is sent electronically from the billing software to the clearinghouse or directly to the insurance carrier. The claim file must be in a acceptable electronic format as defined by the receiver.

E/M - assessment and management section of the Cpt codes. These are the Cpt codes 99201 thru 99499 most used by physicians to passage (or evaluate) a patients medicine needs.

Emr - Electronic curative Records. curative records in digital format of a patients hospital or provider treatment.

Eob - Explanation of Benefits. One of the curative billing terms for the statement that comes with the insurance business payment to the provider explaining payment details, covered charges, write offs, and sick person responsibilities and deductibles.

Era - Electronic Remittance Advice. This is an electronic version of an insurance Eob that provides details of insurance claim payments. These are formatted in agreeing to the Hipaa X12N 835 standard.

Fee agenda - Cost related with each medicine Cpt curative billing codes.

Fraud - When a provider receives payment or a sick person 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 management tasteless course Coding System. (pronounced "hick-picks"). This is a three level system of codes. Cpt is Level I. A standardized curative coding system used to recite specific items or services provided when delivering condition services. May also be referred to as a course 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 contain 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 incommunicable insurers for specific areas or programs.

Hipaa - condition insurance Portability and accountability Act. any federal regulations intended to improve the efficiency and effectiveness of condition care. Hipaa has introduced a lot of new curative 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 system used to assign codes to sick person diagnosis. This is a 3 to 5 digit number.

Icd 10 Code - 10th revising of the International Classification of Diseases. Uses 3 to 7 digit. Includes additional digits to allow more available codes. The U.S. group 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 estimate the insured is responsible for paying for eligible condition plan expenses. When this maximum limit is reached, the insurance typically then pays 100% of eligible expenses.

Medical Assistant - Performs executive and clinical duties to maintain a condition care provider such as a physician, physicians assistant, nurse, or nurse practitioner.

Medical Coder - Analyzes sick person charts and assigns the correct Icd-9 analysis codes (soon to be Icd-10) and corresponding Cpt medicine codes and any related Cpt modifiers.

Medical Billing specialist - The man who processes insurance claims and sick person payments of services performed by a doctor or other condition care provider and vital to the financial performance of a practice. Makes sure curative billing codes and insurance data are entered correctly and submitted to insurance payer. Enters insurance payment data and processes sick person statements and payments.

Medical Necessity - curative service or course performed for medicine of an illness or injury not carefully investigational, cosmetic, or experimental.

Medical Transcription - The conversion of voice recorded or hand written curative data dictated by condition care professionals (such as physicians) into text format records. These records can be either electronic or paper.

Medicare - insurance provided by federal government for habitancy over 65 or habitancy under 65 with confident restrictions. Medicare has 2 parts; Medicare Part A for hospital coverage and Part B for doctors office or sick person care.

Medicare Donut Hole - The gap or distinction in the middle of the preliminary limits of insurance and the catastrophic Medicare Part D coverage limits for prescribe drugs.

Medicaid - insurance coverage for low wage patients. Funded by Federal and state government and administered by states.

Modifier - Modifier to a Cpt medicine code that supply additional data to insurance payers for procedures or services that have been altered or "modified" in some way. Modifiers are foremost to clarify additional procedures and accumulate repayment for them.

Network provider - condition care provider who is contracted with an insurance provider to supply care at a negotiated cost.

Npi estimate - National provider Identifier. A unique 10 digit identification estimate required by Hipaa and assigned straight through the National Plan and provider Enumeration system (Nppes).

Out-of Network (or Non-Participating) - A provider that does not have a compact with the insurance 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 estimate the sick person is responsible to pay under their insurance. Charges above this limit are the insurance clubs obligation. These Out-of-pocket maximums can apply to all coverage or to a specific benefit kind such as prescriptions.

Outpatient - Typically medicine in a physicians office, clinic, or day surgical operation premise continuing less than one day.

Patient accountability - The estimate a sick person is responsible for paying that is not covered by the insurance plan.

Pcp - original Care doctor - ordinarily the doctor who provides preliminary care and coordinates additional care if necessary.

Ppo - beloved provider Organization. insurance plan that allows the sick person to make your mind up a doctor or hospital within the network. Similar to an Hmo.

Practice management Software - software used for the daily operations of a providers office. Typically includes appointment scheduling and billing functions.

Preauthorization - Requirement of insurance plan for original care doctor to edify the sick person insurance carrier of confident curative procedures (such as sick person surgery) for those procedures to be carefully a covered expense.

Premium - The estimate the insured or their owner pays (usually monthly) to the condition insurance business for coverage.

Provider - doctor or curative care premise (hospital) that provides condition care services.

Referral - When a provider (typically the original Care Physician) refers a sick person to other provider (usually a specialist).

Self Pay - payment made at the time of service by the patient.

Secondary insurance Claim - insurance claim for coverage paid after original insurance makes payment. Typically intended to cover gaps in insurance coverage.

Sof - Signature on File.

Superbill - One of the curative billing terms for the form the provider uses to document the medicine and analysis for a sick person visit. Typically includes any commonly used Icd-9 analysis and Cpt procedural codes. One of the most often used curative billing terms.

Supplemental insurance - additional insurance course that covers claims fro deductibles and coinsurance. often used to cover these expenses not covered by Medicare.

Taxonomy Code - Code for the provider specialty sometimes required to process a claim.

Tertiary insurance - insurance paid in addition to original and secondary insurance. Tertiary insurance covers costs the original and secondary insurance may not cover.

Tin - Tax Identification Number. Also known as owner Identification estimate (Ein).

Tos - Type of Service. record of the kind of service 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 estimate created by Cms. Discontinued in 2007 and substituted by Npi number.

Write-off (W/O) - The distinction in the middle of what the provider charges for a course or medicine and what the insurance plan allows. The sick person 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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