15 Important Medical Billing and Coding Terms

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Posted July 31st, 2011 by admin No Comments »

Those in the medical billing and coding field have to know various terms and abbreviations that they will be using on a daily basis. There are some basic terms that you will need to have an understanding of once you enter into the billing and coding field.

1. The maximum amount that the insurance carrier will pay for a certain service performed is the Allowed Expenses.

2. A Claim is filed by the biller to let the insurance carrier that a service has been performed and to request payment.

3. If a patient comes in for service and they are covered by more than one insurance carrier the term used is Coordination of Benefits or ‘COB’.

4. The small amount that must be paid by the patient up-front prior to receiving service is known as the Co-Pay.

5. The treatment that a health plan will and won’t pay is known as Coverage.

6. The date the service or treatment was performed on is Date of Service or ‘DOS’.

7. The out-of-pocket amount that must be paid by the patient before their insurance plan is activated is the Deductible.

8. The list that coders resort to, to code patient medical records and on claim forms is the ICD-9-CM.

9. The group of healthcare professionals who have a contract with a health insurance carrier to perform services at a set rate and a cheaper amount is in a Preferred Provider Organization (PPO).

10. The form that a biller fills out to allow the insurance to remit payment directly to the healthcare provider rather than the patient is the Assignment of Benefits (AOB) form.

11. A group of providers that offer health services at a particular price typically higher than in a PPO is in a Health Maintenance Organization (HMO).

12. A group of healthcare providers contracted with a particular insurance plan carrier is in a Network either a HMO or PPO.

13. The doctor the patient visits first before any other doctor for their medical needs is their Primary Care Physician (PCP). Even though this is the patient’s first point of contact, depending on the severity of their illness they may be referred to a specialist for further examination.

14. In billing it is your job to match the illness with the related treatment this is referred to as a Diagnosis-Related Group (DRG).

15. When a patient is filling out the new patient forms one of the forms they have to sign the Assignment and Authorization form that will allow the healthcare provider to bill the insurance company to receive payment for services.

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