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.
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.
In the world of medical billing and coding, a beneficiary is someone who enjoys the benefits of a specific health insurance policy.
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.
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.
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.
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.
In billing, a ledger is a record of charges, payments, and adjustments for patients or insurers, a staple in medical billing terminology abbreviations.
A code giving extra details about a treatment or service, often influencing reimbursement rates is one of the critical medical billing terminology abbreviations.
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.
Getting a green light from the insurer before availing certain medical services.
Q: Qualified Health Plan
An insurance plan meeting specific government-set standards.
The payment the insurer makes to the healthcare provider for given services.
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.
The amount the provider discounts and doesn’t charge the patient or insurer.
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! 🙂