In a nationally recognized medical billing and coding course you will learn the skills necessary to help you earn your certification and prepare you to be a medical billing and coding professional. One portion of the course that you will have to pay close attention to is the medical terminology portion. This portion of the course will help you to apply the proper terms and spelling. This 2 part article will introduce you to some of the medical billing terms and acronyms that are frequently use medical coding terms.
AOB or Assignment of Benefits is a form that will allow for the insurance provider to pay benefits directly to the doctor, physician or the health care facility and not to the patient.
Assignment & Authorization
This form is signed by a patient that authorizes the healthcare provider to bill the insurance company be paid for their services.
No this is not in reference to the physical age of the patient but to the length of time that an invoice has been unpaid. Specifically this refers balances that have not been paid within at least 30 days.
If an insurance plan will not pay for the treatment that the treatment that the patient received then either the provider or the patient can object and submit and appeal with the insurance company. Further documents may be required before a final judgment is made.
Applied to Deductible
This term is generally seen on the patients invoice or billing statement. This states that X amount has been applied to the deductible through the patient’s insurance plan.
This term refers to the person that is covered under the health plan.
You will see this term quite a bit once both throughout the medical billing and coding course and even on the job. Once a claim is submitted it will go through the clearinghouse and be checked over for errors or information that might be missing and may result in the claim being denied. These Clearinghouses will submit the claim electronically and comply with the strict rules set down by HIPPA.
CMS 1500 Claim Form and CMS
This is a medical claim form established by the Centers for Medicaid and Medicare Services (CMS). While much of the claims forms can be submitted electronically, there are still many commercial insurance companies that paper claim filing via the CMS 1500 form. CMS is the federal agency that administers the health programs such as Medicaid, Medicare, and HIPPA.
Aside from being a payment request, a claim is also a notice that outlines the services performed.
The patient must pay X amount defined by the insurance plan at the end or the beginning of their visit to the medical office.
Coordination of Benefits (COB )
Term used for patients that are covered by more than one health plan for whatever reason.
This is the amount the patient will have to pay the medical office out of pocket prior to their insurance company paying the rest of the amount.
Diagnosis-Related Groups (DRG)
For the purpose of billing this is when the patient’s illness will be matched with the treatment they received.
Date of Service
Also known as DOS, this is the date that the patient received services.
The Day Sheet is a summary of any treatments given to the patient, payments received and charges.
The patient’s physical demographics include their age, sexuality, address, and any other personal information needed to file a claim.
Durable Medical Equipment (DME)
Wheelchairs, oxygen, walkers, crutches, catheters, etc. are all examples of DME.
Electronic Medical Records (EMR)
This is a term for medical records that are in electronic or digital format.
Explanation of Benefits (EOB)
This is a statement sent to the provider from the insurance company that details payments, charges they cover and deductibles and other patient responsibilities.