You are currently viewing Medical Billing Glossary 1.0: For Providers and Practice Managers

Medical Billing Glossary 1.0: For Providers and Practice Managers

  • Post author:
  • Post category:Uncategorized
  • Post comments:0 Comments

Ever looked at a medical bill and felt completely lost? You’re not alone. The world of healthcare is filled with terms and phrases that can seem like a whole different language. Whether you’re trying to make sense of a bill, starting a job in healthcare, or just curious, it’s helpful to know what these terms mean. That’s where this glossary comes in. We’ve put together a list of basic terms and their explanations to help make things clearer. Think of it as a friendly guide to help you navigate the sometimes or maybe every time confusing world of medical billing and coding terminology.

A: Adjustment

Adjustments are tweaks made to a patient’s bill. They can either increase or decrease the total due to reasons like contractual agreements or corrections. It’s a key part of medical billing terminology.

B: Beneficiary

In the world of medical billing and coding, a beneficiary is someone who enjoys the benefits of a specific health insurance policy.

C: Copayment

Often termed ‘copay’, this is a set amount a patient pays for a covered health service. Their insurance handles the rest. It’s a term often found in medical billing terminology abbreviations.

D: Deductible

A foundational concept in basic medical billing terminology, the deductible is what a patient pays for health services before insurance steps in.

E: Explanation of Benefits (EOB)

EOB, a crucial medical terminology for billing and coding, is a note from the insurer to the patient. It details covered services, the insurance’s payment, and any patient dues.

F: Fee-for-Service

Here, services are unbundled and billed separately. 

G: Group Health Plan

This insurance plan offers health coverage to a group, often via employers. It’s a common medical billing terminology.

H: Health Insurance Portability and Accountability Act (HIPAA)

HIPAA safeguards patient health details. It’s a federal act granting patients rights over their health data, a key medical terminology for medical billing and coding.

I: ICD-10-CM

Short for International Classification of Diseases, 10th Edition, Clinical Modification. Healthcare pros use this system to classify all diagnoses, symptoms, and procedures.

J: Justification of Treatment

This is the needed documentation explaining the necessity of a specific treatment, a term often encountered in medical billing and coding medical terminology.

L: Ledger

In billing, a ledger is a record of charges, payments, and adjustments for patients or insurers, a staple in medical billing terminology abbreviations.

M: Modifier

A code giving extra details about a treatment or service, often influencing reimbursement rates is one of the critical medical billing terminology abbreviations.

N: Network

A group of healthcare providers and establishments offering services to insured folks at agreed rates. 

O: Out-of-Pocket Maximum

The maximum a patient pays for covered services in a policy period. Post this, insurance covers all costs.

P: Preauthorization

Getting a green light from the insurer before availing certain medical services.

Q: Qualified Health Plan

An insurance plan meeting specific government-set standards.

R: Reimbursement

The payment the insurer makes to the healthcare provider for given services.

S: Superbill

A detailed form about a patient’s visit, superbill is a common medical billing terminology that includes diagnosis and treatment, sent to the insurer for reimbursement

T: Third-Party Payer

An entity, like an insurance company, pays medical bills on the insured’s behalf.

U: Utilization Review

A review of the need, aptness, and efficiency of health services.

V: Verification of Benefits

Checking a patient’s insurance coverage to ensure services are covered is known as VOB. It is an important medical billing and coding medical terminology that healthcare staff should know about.

W: Write-Off

The amount the provider discounts and doesn’t charge the patient or insurer.

In Closing

So there you have it! With this guide, we hope you feel a bit more confident the next time you come across a term you don’t recognize. Remember, understanding these terms is a big step towards making healthcare a little less confusing for everyone. Happy learning! 🙂

Leave a Reply