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.
Aging - Refers to the unpaid assurance claims or patient balances that are due past 30 days. Most curative billing software's have the capability to generate a separate narrative 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 provider or patient) is the process of formally objecting this judgment. The insurer may need additional documentation.
Applied to Deductible - Typically seen on the patient statement. This is the whole of the charges, carefully by the patients assurance plan, the patient 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 physician or hospital for a patients treatment.
Beneficiary - someone 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 whole of rejected claims as most errors can be positively corrected. Clearinghouses electronically forward claim facts that is compliant with the literal, 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 branch which administers Medicare, Medicaid, Hippa, and other health 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 assurance carriers also need paper claims be submitted on Cms-1500's. The form is suited by it's red ink.
Coding -Medical Billing Coding involves taking the doctors notes from a patient visit and translating them into the proper Icd-9 code for pathology and Cpt codes for treatment.
Co-Insurance - ration or whole 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 - whole 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 course performed by the physician. The Cpt has a corresponding Icd-9 pathology 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 - overview of daily patient treatments, charges, and payments received.
Deductible - whole 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 any doctor's visits or prescriptions to reach the deductible.
Demographics - physical characteristics of a patient such as age, sex, address, etc. Valuable 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 pathology code (Icd-9-Cm).
Electronic Claim - Claim facts is sent electronically from the billing software to the clearinghouse or directly to the assurance carrier. The claim file must be in a approved 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 access (or evaluate) a patients rehabilitation 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 assurance enterprise cost to the provider explaining cost 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 agreeing to the Hipaa X12N 835 standard.
Fee program - Cost related with each rehabilitation Cpt curative billing codes.
Fraud - When a provider receives cost 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 common 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 quote exact items or services in case,granted when delivering health 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 consist of 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. any federal regulations intended to heighten 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 system 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 additional 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 whole 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 maintain a health care provider such as a physician, physicians assistant, nurse, or nurse practitioner.
Medical Coder - Analyzes patient charts and assigns the literal, Icd-9 pathology codes (soon to be Icd-10) and corresponding Cpt rehabilitation codes and any related Cpt modifiers.
Medical Billing expert - The someone who processes assurance claims and patient payments of services performed by a physician or other health care provider and vital to the financial execution of a practice. Makes sure curative billing codes and assurance facts are entered correctly and submitted to assurance payer. Enters assurance cost facts and processes patient statements and payments.
Medical Necessity - curative assistance or course performed for rehabilitation of an illness or injury not carefully investigational, cosmetic, or experimental.
Medical Transcription - The conversion of voice recorded or hand written curative facts dictated by health care professionals (such as physicians) into text format records. These records can be whether electronic or paper.
Medicare - assurance in case,granted by federal government for habitancy over 65 or habitancy under 65 with definite 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 discrepancy between the preliminary limits of assurance and the catastrophic Medicare Part D coverage limits for prescription 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 additional facts to assurance payers for procedures or services that have been altered or "modified" in some way. Modifiers are important to elaborate additional procedures and regain refund for them.
Network provider - health care provider who is contracted with an assurance provider to supply care at a negotiated cost.
Npi whole - National provider Identifier. A unique 10 digit identification whole required by Hipaa and assigned through the National Plan and provider Enumeration system (Nppes).
Out-of Network (or Non-Participating) - A provider that does not have a contract with the assurance carrier. Patients usually 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 whole the patient 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 exact benefit category such as prescriptions.
Outpatient - Typically rehabilitation in a physicians office, clinic, or day surgery factory persisting less than one day.
Patient responsibility - The whole a patient is responsible for paying that is not covered by the assurance plan.
Pcp - former Care physician - usually the physician who provides preliminary care and coordinates additional care if necessary.
Ppo - adored provider Organization. assurance plan that allows the patient to go for 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 former care physician to wise up the patient assurance carrier of definite curative procedures (such as patient surgery) for those procedures to be carefully a covered expense.
Premium - The whole the insured or their manager pays (usually monthly) to the health assurance enterprise for coverage.
Provider - physician or curative care factory (hospital) that provides health care services.
Referral - When a provider (typically the former Care Physician) refers a patient to an additional one provider (usually a specialist).
Self Pay - cost made at the time of assistance by the patient.
Secondary assurance Claim - assurance claim for coverage paid after former 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 provider uses to document the rehabilitation and pathology for a patient visit. Typically includes any ordinarily used Icd-9 pathology and Cpt procedural codes. One of the most oftentimes used curative billing terms.
Supplemental assurance - additional assurance course that covers claims fro deductibles and coinsurance. oftentimes 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 former and secondary insurance. Tertiary assurance covers costs the former and secondary assurance may not cover.
Tin - Tax Identification Number. Also known as manager Identification whole (Ein).
Tos - Type of Service. narrative of the category of assistance performed.
Ub04 - Claim form for hospitals, clinics, or any provider billing for factory 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 whole created by Cms. Discontinued in 2007 and substituted by Npi number.
Write-off (W/O) - The discrepancy between what the provider charges for a course 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.healing Billing Terms and healing Coding Terminology