curative Billing Terms and curative Coding Terminology

Self Employed Health Insurance Deduction Medicare Part B - curative Billing Terms and curative Coding Terminology

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

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Self Employed Health Insurance Deduction Medicare Part B

Aging - Refers to the unpaid assurance claims or patient balances that are due past 30 days. Most medical billing software's have the quality to originate a cut off description 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 require supplementary documentation.

Applied to Deductible - Typically seen on the patient statement. This is the number of the charges, considered 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 doctor or hospital for a patients treatment.

Beneficiary  - person or persons covered by the condition 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 well corrected. Clearinghouses electronically send claim data that is compliant with the accurate Hippa standards (this is one of the medical 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 condition programs. Formerly known as the Hcfa (Health Care Financing Administration). You'll consideration that Cms it the source of a lot of medical billing terms.

Cms 1500 - medical claim form established by Cms to submit paper claims to Medicare and Medicaid. Most market assurance carriers also require paper claims be submitted on Cms-1500's. The form is considerable by it's red ink.

Coding -Medical Billing Coding involves taking the doctors notes from a patient visit and translating them into the allowable Icd-9 code for pathology and Cpt codes for treatment.

Co-Insurance - ration or number 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 - number 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 procedure performed by the physician. The Cpt has a corresponding Icd-9 pathology code. Established by the American medical Association. This is one of the medical billing terms we use a lot.

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

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

Deductible - number patient must pay before assurance coverage begins. For example, a patient could have a 00 deductible per year before their condition assurance will begin paying. This could take several doctor's visits or prescriptions to reach the deductible.

Demographics - corporeal characteristics of a patient such as age, sex, address, etc. Vital for filing a claim.

Dme - Durable medical equipment - medical 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 data 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 - assessment 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 medical Records. medical records in digital format of a patients hospital or supplier treatment.

Eob - Explanation of Benefits. One of the medical billing terms for the statement that comes with the assurance enterprise 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 agreeing to the Hipaa X12N 835 standard.

Fee schedule - Cost associated with each medicine Cpt medical 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 - condition Care Financing supervision common procedure Coding System. (pronounced "hick-picks"). This is a three level theory of codes. Cpt is Level I. A standardized medical coding theory used to characterize specific items or services provided when delivering condition services. May also be referred to as a procedure code in the medical billing glossary.

The three Hcpcs levels are:

Level I - American medical Associations Current Procedural Terminology (Cpt) codes.

Level Ii - The alphanumeric codes which include mostly non-physician items or services such as medical 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 inexpressive insurers for specific areas or programs.

Hipaa - condition assurance Portability and responsibility Act. several federal regulations intended to heighten the efficiency and effectiveness of condition care. Hipaa has introduced a lot of new medical 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 theory used to assign codes to patient 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 supplementary digits to allow more ready codes. The U.S. division 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 number the insured is responsible for paying for eligible condition 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 condition care supplier such as a physician, physicians assistant, nurse, or nurse practitioner.

Medical Coder - Analyzes patient charts and assigns the accurate Icd-9 pathology codes (soon to be Icd-10) and corresponding Cpt medicine codes and any associated Cpt modifiers.

Medical Billing devotee - The person who processes assurance claims and patient payments of services performed by a doctor or other condition care supplier and vital to the financial doing of a practice. Makes sure medical billing codes and assurance data are entered correctly and submitted to assurance payer. Enters assurance payment data and processes patient statements and payments.

Medical Necessity - medical aid or procedure performed for medicine of an illness or injury not considered investigational, cosmetic, or experimental.

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

Medicare - assurance provided by federal government for habitancy over 65 or habitancy under 65 with safe bet 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 contrast between the preliminary limits of assurance and the catastrophic Medicare Part D coverage limits for prescribe drugs.

Medicaid - assurance coverage for low income patients. Funded by Federal and state government and administered by states.

Modifier - Modifier to a Cpt medicine code that provide supplementary data to assurance payers for procedures or services that have been altered or "modified" in some way. Modifiers are leading to by comparison supplementary procedures and gather refund for them.

Network supplier - condition care supplier who is contracted with an assurance supplier to provide care at a negotiated cost.

Npi number - National supplier Identifier. A unique 10 digit identification number required by Hipaa and assigned straight through the National Plan and supplier Enumeration theory (Nppes).

Out-of Network (or Non-Participating) - A supplier that does not have a covenant with the assurance 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 number the patient is responsible to pay under their insurance. Charges above this limit are the assurance clubs obligation. These Out-of-pocket maximums can apply to all coverage or to a specific advantage class such as prescriptions.

Outpatient - Typically medicine in a physicians office, clinic, or day surgery premise lasting less than one day.

Patient responsibility - The number a patient is responsible for paying that is not covered by the assurance plan.

Pcp - customary Care doctor - regularly the doctor who provides preliminary care and coordinates supplementary care if necessary.

Ppo - beloved supplier Organization. assurance plan that allows the patient to adopt 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 customary care doctor to post the patient assurance carrier of safe bet medical procedures (such as patient surgery) for those procedures to be considered a covered expense.

Premium - The number the insured or their manager pays (usually monthly) to the condition assurance enterprise for coverage.

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

Referral - When a supplier (typically the customary Care Physician) refers a patient to someone else supplier (usually a specialist).

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

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

Sof - Signature on File.

Superbill - One of the medical billing terms for the form the supplier uses to document the medicine and pathology for a patient visit. Typically includes several ordinarily used Icd-9 pathology and Cpt procedural codes. One of the most oftentimes used medical billing terms.

Supplemental assurance - supplementary assurance procedure 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 expanding to customary and secondary insurance. Tertiary assurance covers costs the customary and secondary assurance may not cover.

Tin - Tax Identification Number. Also known as manager Identification number (Ein).

Tos - Type of Service. description of the class of aid 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 medicine code when only one is appropriate.

Upin - Unique doctor Identification Number. 6 digit doctor identification number created by Cms. Discontinued in 2007 and replaced by Npi number.

Write-off (W/O) - The contrast between what the supplier charges for a procedure or medicine 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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