medical Billing Terms and medical Coding Terminology

Can I Deduct Health Insurance Premiums - medical Billing Terms and medical 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 often used healing Billing terms and acronyms. Also included is some healing coding terminology.

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Can I Deduct Health Insurance Premiums

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

Applied to Deductible - Typically seen on the patient statement. This is the number of the charges, thought about by the patients guarnatee plan, the patient 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  - person or persons covered by the health guarnatee plan.

Clearinghouse - This is a service that transmits claims to guarnatee 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 absolutely corrected. Clearinghouses electronically send claim data that is compliant with the correct 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 branch which administers Medicare, Medicaid, Hippa, and other health programs. Formerly known as the Hcfa (Health Care Financing Administration). You'll notice 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 market guarnatee carriers also require paper claims be submitted on Cms-1500's. The form is mighty by it's red ink.

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

Co-Insurance - percentage or number defined in the guarnatee plan for which the patient 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 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 course performed by the physician. The Cpt has a corresponding Icd-9 analysis code. Established by the American healing Association. This is one of the healing billing terms we use a lot.

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

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

Deductible - number patient must pay before guarnatee coverage begins. For example, a patient could have a 00 deductible per year before their health guarnatee 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. Primary for filing a claim.

Dme - Durable healing equipment - healing supplies such as wheelchairs, oxygen, catheter, glucose monitors, crutches, walkers, etc.

Dob - Abbreviation for Date of Birth

Dx - Abbreviation for analysis 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 proper electronic format as defined by the receiver.

E/M - evaluation and management section of the Cpt codes. These are the Cpt codes 99201 thru 99499 most used by physicians to entrance (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 business cost to the victualer explaining cost details, covered charges, write offs, and patient 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 agenda - Cost connected with each treatment Cpt healing billing codes.

Fraud - When a victualer 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 management tasteless course Coding System. (pronounced "hick-picks"). This is a three level ideas of codes. Cpt is Level I. A standardized healing coding ideas used to characterize 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 comprise 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 private insurers for specific areas or programs.

Hipaa - health guarnatee Portability and accountability Act. any 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 ideas 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 further 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 number 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 sustain a health care victualer such as a physician, physicians assistant, nurse, or nurse practitioner.

Medical Coder - Analyzes patient charts and assigns the correct Icd-9 analysis codes (soon to be Icd-10) and corresponding Cpt treatment codes and any connected Cpt modifiers.

Medical Billing devotee - The person who processes guarnatee claims and patient payments of services performed by a doctor or other health care victualer and vital to the financial execution 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 patient statements and payments.

Medical Necessity - healing service or course performed for treatment of an illness or injury not thought about 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 citizen over 65 or citizen under 65 with sure 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 dissimilarity 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 earnings patients. Funded by Federal and state government and administered by states.

Modifier - Modifier to a Cpt treatment code that contribute further data to guarnatee payers for procedures or services that have been altered or "modified" in some way. Modifiers are prominent to elucidate further procedures and obtain repayment for them.

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

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

Out-of Network (or Non-Participating) - A victualer that does not have a contract with the guarnatee carrier. Patients regularly responsible for a greater portion 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 guarnatee companies obligation. These Out-of-pocket maximums can apply to all coverage or to a specific benefit category such as prescriptions.

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

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

Pcp - primary Care doctor - regularly the doctor who provides introductory care and coordinates further care if necessary.

Ppo - adored victualer Organization. guarnatee plan that allows the patient to elect a doctor or hospital within the network. Similar to an Hmo.

Practice management 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 doctor to fill in the patient guarnatee carrier of sure healing procedures (such as patient surgery) for those procedures to be thought about a covered expense.

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

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

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

Self Pay - cost made at the time of service 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 healing billing terms for the form the victualer uses to document the treatment and analysis for a patient visit. Typically includes any commonly used Icd-9 analysis and Cpt procedural codes. One of the most often used healing billing terms.

Supplemental guarnatee - further guarnatee course that covers claims fro deductibles and coinsurance. often 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 expanding 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 number (Ein).

Tos - Type of Service. report of the category of service performed.

Ub04 - Claim form for hospitals, clinics, or any victualer billing for installation 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 number created by Cms. Discontinued in 2007 and supplanted by Npi number.

Write-off (W/O) - The dissimilarity in the middle of what the victualer charges for a course or treatment and what the guarnatee 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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