curative Billing Terms and curative Coding Terminology

Health Insurance Claim Form 1500 Download - 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 frequently used medical Billing terms and acronyms. Also included is some medical coding terminology.

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Health Insurance Claim Form 1500 Download

Aging - Refers to the unpaid guarnatee claims or inpatient balances that are due past 30 days. Most medical billing software's have the quality to generate a separate narrative for guarnatee aging and inpatient aging. These reports typically list balances by 30, 60, 90, and 120 day increments.

Appeal - When an guarnatee plan does not pay for treatment, an motion (either by the provider or patient) is the process of formally objecting this judgment. The insurer may require supplementary documentation.

Applied to Deductible - Typically seen on the inpatient statement. This is the amount of the charges, determined by the patients guarnatee plan, the inpatient owes the provider. Many plans have a maximum yearly deductible that once met is then covered by the guarnatee provider.

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

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

Clearinghouse - This is a assistance that transmits claims to guarnatee carriers. Prior to submitting claims the clearinghouse scrubs claims and checks for errors. This minimizes the amount of rejected claims as most errors can be verily corrected. Clearinghouses electronically forward claim data that is compliant with the literal, 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 group which administers Medicare, Medicaid, Hippa, and other condition programs. Once known as the Hcfa (Health Care Financing Administration). You'll observation 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 guarnatee carriers also require 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 inpatient visit and translating them into the allowable Icd-9 code for determination and Cpt codes for treatment.

Co-Insurance - ration or amount defined in the guarnatee plan for which the inpatient is responsible. Most plans have a ratio of 90/10 or 80/20, 70/30, etc. For example the guarnatee carrier pays 80% and the inpatient pays 20%.

Co-Pay - amount 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 medical Association. This is one of the medical billing terms we use a lot.

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

Day Sheet - summary of daily inpatient treatments, charges, and payments received.

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

Demographics - physical characteristics of a inpatient such as age, sex, address, etc. Requisite for filing a claim.

Dme - Durable medical tool - medical 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 data is sent electronically from the billing software to the clearinghouse or directly to the guarnatee carrier. The claim file must be in a appropriate electronic format as defined by the receiver.

E/M - estimate and supervision 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 medical Records. medical records in digital format of a patients hospital or provider treatment.

Eob - Explanation of Benefits. One of the medical billing terms for the statement that comes with the guarnatee business 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 guarnatee Eob that provides details of guarnatee claim payments. These are formatted in agreeing to the Hipaa X12N 835 standard.

Fee schedule - Cost associated with each rehabilitation Cpt medical 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 - condition Care Financing supervision tasteless policy Coding System. (pronounced "hick-picks"). This is a three level principles of codes. Cpt is Level I. A standardized medical coding principles used to enumerate definite items or services in case,granted when delivering condition services. May also be referred to as a policy 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 comprise 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 incommunicable insurers for definite areas or programs.

Hipaa - condition guarnatee Portability and responsibility Act. any federal regulations intended to improve 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 principles used to assign codes to inpatient 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 supplementary digits to allow more ready 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 amount the insured is responsible for paying for eligible condition plan expenses. When this maximum limit is reached, the guarnatee typically then pays 100% of eligible expenses.

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

Medical Coder - Analyzes inpatient charts and assigns the literal, Icd-9 determination codes (soon to be Icd-10) and corresponding Cpt rehabilitation codes and any associated Cpt modifiers.

Medical Billing expert - The man who processes guarnatee claims and inpatient payments of services performed by a physician or other condition care provider and vital to the financial carrying out of a practice. Makes sure medical billing codes and guarnatee data are entered correctly and submitted to guarnatee payer. Enters guarnatee cost data and processes inpatient statements and payments.

Medical Necessity - medical assistance or policy performed for rehabilitation of an illness or injury not determined 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 either electronic or paper.

Medicare - guarnatee in case,granted 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 inpatient care.

Medicare Donut Hole - The gap or disagreement between the initial limits of guarnatee and the catastrophic Medicare Part D coverage limits for prescribe drugs.

Medicaid - guarnatee coverage for low earnings patients. Funded by Federal and state government and administered by states.

Modifier - Modifier to a Cpt rehabilitation code that furnish supplementary data to guarnatee payers for procedures or services that have been altered or "modified" in some way. Modifiers are prominent to clarify supplementary procedures and secure reimbursement for them.

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

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

Out-of Network (or Non-Participating) - A provider that does not have a compact with the guarnatee 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 amount the inpatient is responsible to pay under their insurance. Charges above this limit are the guarnatee fellowships obligation. These Out-of-pocket maximums can apply to all coverage or to a definite advantage kind such as prescriptions.

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

Patient responsibility - The amount a inpatient is responsible for paying that is not covered by the guarnatee plan.

Pcp - primary Care physician - usually the physician who provides initial care and coordinates supplementary care if necessary.

Ppo - adored provider Organization. guarnatee plan that allows the inpatient to take a physician 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 guarnatee plan for primary care physician to notify the inpatient guarnatee carrier of confident medical procedures (such as inpatient surgery) for those procedures to be determined a covered expense.

Premium - The amount the insured or their employer pays (usually monthly) to the condition guarnatee business for coverage.

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

Referral - When a provider (typically the primary Care Physician) refers a inpatient to someone else provider (usually a specialist).

Self Pay - cost made at the time of assistance by the patient.

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

Sof - Signature on File.

Superbill - One of the medical billing terms for the form the provider uses to document the rehabilitation and determination for a inpatient visit. Typically includes any commonly used Icd-9 determination and Cpt procedural codes. One of the most frequently used medical billing terms.

Supplemental guarnatee - supplementary guarnatee 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 guarnatee - guarnatee paid in addition to primary and secondary insurance. Tertiary guarnatee covers costs the primary and secondary guarnatee may not cover.

Tin - Tax Identification Number. Also known as employer Identification amount (Ein).

Tos - Type of Service. narrative of the kind of assistance 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 rehabilitation code when only one is appropriate.

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

Write-off (W/O) - The disagreement between what the provider charges for a policy or rehabilitation and what the guarnatee 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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