curative Billing Terms and curative Coding Terminology

Medicare Premiums Tax Deductible - curative Billing Terms and curative Coding Terminology

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

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Aging - Refers to the unpaid guarnatee claims or outpatient balances that are due past 30 days. Most healing billing software's have the capability to originate a separate description for guarnatee aging and outpatient 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 request for retrial (either by the victualer or patient) is the process of formally objecting this judgment. The insurer may require added documentation.

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

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

Beneficiary  - someone or persons covered by the health 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 whole of rejected claims as most errors can be well corrected. Clearinghouses electronically transmit claim data that is compliant with the literal, Hippa standards (this is one of the healing billing terms we see a lot more of lately).

Cms - Centers for Medicaid and Medicare Services. Federal department which administers Medicare, Medicaid, Hippa, and other health programs. Formerly known as the Hcfa (Health Care Financing Administration). You'll consideration that Cms it the source of a lot of healing billing terms.

Cms 1500 - healing claim form established by Cms to submit paper claims to Medicare and Medicaid. Most commercial guarnatee carriers also require paper claims be submitted on Cms-1500's. The form is remarkable by it's red ink.

Coding -Medical Billing Coding involves taking the doctors notes from a outpatient 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 guarnatee plan for which the outpatient 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 outpatient pays 20%.

Co-Pay - whole paid by outpatient 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 healing Association. This is one of the healing billing terms we use a lot.

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

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

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

Demographics - bodily characteristics of a outpatient such as age, sex, address, etc. Valuable for filing a claim.

Dme - Durable healing tool - healing 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 guarnatee carrier. The claim file must be in a acceptable 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 passage (or evaluate) a patients treatment needs.

Emr - Electronic healing Records. healing records in digital format of a patients hospital or victualer treatment.

Eob - Explanation of Benefits. One of the healing billing terms for the statement that comes with the guarnatee company cost to the victualer explaining cost details, covered charges, write offs, and outpatient 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 according to the Hipaa X12N 835 standard.

Fee program - Cost associated with each treatment Cpt healing billing codes.

Fraud - When a victualer receives cost or a outpatient 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 supervision base course Coding System. (pronounced "hick-picks"). This is a three level system of codes. Cpt is Level I. A standardized healing coding system used to recapitulate specific items or services provided when delivering health services. May also be referred to as a course code in the healing billing glossary.

The three Hcpcs levels are:

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

Level Ii - The alphanumeric codes which contain mostly non-physician items or services such as healing 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 - health guarnatee Portability and accountability Act. several federal regulations intended to improve the efficiency and effectiveness of health care. Hipaa has introduced a lot of new healing 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 outpatient 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 added digits to allow more available codes. The U.S. department 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 guarnatee typically then pays 100% of eligible expenses.

Medical Assistant - Performs administrative and clinical duties to preserve a health care victualer such as a physician, physicians assistant, nurse, or nurse practitioner.

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

Medical Billing specialist - The someone who processes guarnatee claims and outpatient payments of services performed by a doctor or other health care victualer and vital to the financial doing of a practice. Makes sure healing billing codes and guarnatee data are entered correctly and submitted to guarnatee payer. Enters guarnatee cost data and processes outpatient statements and payments.

Medical Necessity - healing assistance or course performed for treatment of an illness or injury not carefully investigational, cosmetic, or experimental.

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

Medicare - guarnatee provided by federal government for population over 65 or population under 65 with determined restrictions. Medicare has 2 parts; Medicare Part A for hospital coverage and Part B for doctors office or outpatient care.

Medicare Donut Hole - The gap or contrast in the middle of the introductory limits of guarnatee and the catastrophic Medicare Part D coverage limits for prescription drugs.

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

Modifier - Modifier to a Cpt treatment code that provide added data to guarnatee payers for procedures or services that have been altered or "modified" in some way. Modifiers are prominent to illustrate added procedures and gather refund for them.

Network victualer - health care victualer who is contracted with an guarnatee victualer to provide care at a negotiated cost.

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

Out-of Network (or Non-Participating) - A victualer that does not have a contract with the guarnatee carrier. Patients normally 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 whole the outpatient is responsible to pay under their insurance. Charges above this limit are the guarnatee companies obligation. These Out-of-pocket maximums can apply to all coverage or to a specific advantage category such as prescriptions.

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

Patient accountability - The whole a outpatient is responsible for paying that is not covered by the guarnatee plan.

Pcp - original Care doctor - normally the doctor who provides introductory care and coordinates added care if necessary.

Ppo - favorite victualer Organization. guarnatee plan that allows the outpatient to take 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 guarnatee plan for original care doctor to warn the outpatient guarnatee carrier of determined healing procedures (such as outpatient surgery) for those procedures to be carefully a covered expense.

Premium - The whole the insured or their owner pays (usually monthly) to the health guarnatee company for coverage.

Provider - doctor or healing care facility (hospital) that provides health care services.

Referral - When a victualer (typically the original Care Physician) refers a outpatient to an additional one victualer (usually a specialist).

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

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

Sof - Signature on File.

Superbill - One of the healing billing terms for the form the victualer uses to document the treatment and pathology for a outpatient visit. Typically includes several ordinarily used Icd-9 pathology and Cpt procedural codes. One of the most oftentimes used healing billing terms.

Supplemental guarnatee - added guarnatee course that covers claims fro deductibles and coinsurance. oftentimes used to cover these expenses not covered by Medicare.

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

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

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

Tos - Type of Service. description of the category of assistance performed.

Ub04 - Claim form for hospitals, clinics, or any victualer billing for facility fees similar to Cms 1500. Replaces the Ub92 form.

Unbundling - Submitting more than one Cpt treatment code when only one is appropriate.

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

Write-off (W/O) - The contrast in the middle of what the victualer charges for a course or treatment and what the guarnatee plan allows. The outpatient 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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