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! 🙂
