Accounts Receivable: Accounts receivable (AR) refers to money owed by customers (individuals or corporations) to another entity in exchange for goods or services that have been delivered or used, but not yet paid for.
Aging Report: A report used in collections and accounting that shows the money owed by insurance companies or patients. The aging report will list each patient or insurance companies’ outstanding balance and will then sort the total amount into columns such as: Current, 1-30 days past due, 31-60 days past due, 61-90 days past due, 91-120 days past due, and 120+ days past due.
AR: See “Accounts Receivable”
Balance Billing: Balance billing, sometimes also called extra billing, is the practice of a healthcare provider billing a patient for the difference between what the patient's health insurance chooses to reimburse and what the provider chooses to charge.
Bill: send a note of charges to (someone). (See “Medical Billing”)
Bundling: claims are "bundled" when a payer refuses to pay for two separate services a practice has billed. Instead, it groups, or bundles, the two charges and pays only one, smaller fee.
Business Associate Agreement: The Privacy Rule portion of the Health Insurance Portability and Accountability Act (HIPAA) of 1996 defines a "business associate (BA)" as a person or entity that performs certain functions or activities that involve the use or disclosure of protected health information (PHI) on behalf of, or provides services to, a covered entity (CE)."1 The rule requires that a covered entity obtain satisfactory assurance in writing—in the form of a contract or other agreement—from their business associates of their commitment to appropriately safeguard PHI. Such assurances safeguard the PHI obtained, created, or received on behalf of the CE in the performance of the BA's duties for the CE. The rule excludes from the definition of BAs the CE's own workforce.
Chart abstraction is the process of collecting important information from a patient's medical record and transcribing that information into discrete fields or locations within the new EHR
Claim: (v.) make a demand for (money) under the terms of an insurance policy.
In billing it is used as a noun to represent the form, electronic or paper, that makes such a demand. Example: “Did you submit his claim?”
Also sometimes used to represent the treatment and administration associated with a patient’s treatment concerning such a demand. Example: “He was treated under his Personal Injury claim today.”
Clearinghouse: Medical billing clearinghouses take claim information from a billing service or provider, check the claims for errors, and send this claim information electronically to insurance companies. Claims sent electronically are paid much faster than paper claims.
The Benefits of using a Clearinghouse are:
Electronic Health Record: An electronic health record (EHR) is a digital version of a patient's paper chart. EHRs are real-time, patient-centered records that make information available instantly and securely to authorized users.
DME: Stands for Durable Medical Equipment
DMEPOS: Stands for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies. (See “Durable Medical Equipment” and “Orthotics”)
Durable Medical Equipment: Durable Medical Equipment (DME) is any equipment that provides therapeutic benefits to a patient in need because of certain medical conditions and/or illnesses.
EOB: See Explanation of benefits
Explanation of benefits: An explanation of benefits (commonly referred to as an EOB form) is a statement sent by a health insurance company to covered individuals explaining what medical treatments and/or services were paid for on their behalf. The EOB is commonly attached to a check or statement of electronic payment.
Flex Spending Account: A Flexible Spending Account (also known as a flexible spending arrangement) is a special account you put money into that you use to pay for certain out-of-pocket health care costs. You don't pay taxes on this money. This means you'll save an amount equal to the taxes you would have paid on the money you set aside.
Group Health Insurance: An insurance plan that provides healthcare coverage to a select group of people. Group health insurance plans are one of the major benefits offered by many employers. These plans are generally uniform in nature, offering the same benefits to all employees or members of the group.
Health Insurance: Health insurance is a type of insurance coverage that pays for medical and surgical expenses that are incurred by the insured.Health insurance can either reimburse the insured for expenses incurred from illness or injury or pay the care provider directly.
HCPCS Code (Hick-pick): HCPCS is an acronym for Healthcare Common Procedure Coding System (HCPCS). HCPCS Level II coding system is one of several code sets used by healthcare professionals, including medical coders and billers. The Level I HCPCS code set includes CPT® (Current Procedural Terminology) codes. CPT is developed and owned by the American Medical Association (AMA).
The code set is made up of five-character, alpha-numeric codes mainly representing medical supplies, durable medical goods, non-physician services, and services not represented in the Level I code set (CPT®). HCPCS Level II includes services such as ambulance, durable medical equipment, prosthetics, orthotics and supplies (DMEPOS), when used outside a physician’s office. This coding system is also used as an official code set for outpatient hospital care, chemotherapy drugs, Medicaid, and other services.
HIPAA: (Health Insurance Portability and Accountability Act of 1996) is United States legislation that provides data privacy and security provisions for safeguarding medical information.
HMO: A health maintenance organization (HMO) is an organization that provides health coverage with providers under contract. A Health Maintenance Organization (HMO) differs from traditional health insurance by the contracts it has with its providers.
An HMO gives you access to certain doctors and hospitals within its network. A network is made up of providers that have agreed to lower their rates for plan members and also meet quality standards. But unlike other insurance plan types, care is covered only if you see a provider within that HMO’s network. There are few opportunities to see a non-network provider. There are also typically more restrictions for coverage than other plans, such as allowing only a certain number of visits, tests or treatments.
HSA (Health Savings Account): A health savings account (HSA) is a tax-advantaged medical savings account available to taxpayers in the United States who are enrolled in a high-deductible health plan (HDHP). The funds contributed to an account are not subject to federal income tax at the time of deposit.
ICD-9 Codes: The International Classification of Diseases, Ninth Revision. The international standard list of six-character alphanumeric codes to describe diagnoses.
ICD-9-CM: The International Classification of Diseases, Ninth Revision, Clinical Modification. The U.S. health system's adaptation of international ICD-9 standard list of six-character alphanumeric codes to describe diagnoses. ICD-9-CM contains a list of codes corresponding to diagnoses and procedures recorded in conjunction with hospital care in the United States. These codes may be entered onto a patient's electronic health record and used for diagnostic, billing and reporting purposes. Related information also classified and codified in the system includes symptoms, patient complaints, causes of injury, and mental disorders.
ICD-10-CM: The International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) is a system used by physicians and other healthcare providers to classify and code all diagnoses, symptoms and procedures recorded in conjunction with hospital care in the United States. The ICD-10-CM revision includes more than 68,000 diagnostic codes, compared to 13,000 in ICD-9-CM. In addition, ICD-10-CM codes include twice as many categories. ICD-10-CM diagnosis codes consist of three to seven digits, compared to the three to five digit system of ICD-9-CM. The increase in the amount and length of ICD-10-CM codes will allow for greater coding specificity.
Incident to: "Incident to" services are defined as services or supplies furnished as an integral, although incidental, part of the physician's personal professional services in the course of diagnosis or treatment of an injury or illness. Reimbursement. Reimbursement is based on 100% of the physician fee schedule amount.
In-network: A health insurance provider network is a group of health care providers that have contracted with an HMO or PPO to provide care at a discount. “In-network” refers to a provider who has signed a contract to be in such network.
An in-network provider contracts to accept a lower fee is not allowed to “balance bill” a patient. A provider who is not contracted to be in-network, is “out of network”, and may balance bill. (See “balance billing”)
Medical Billing: Medical billing is the process of submitting and following up on claims with health insurance companies in order to receive payment for services rendered by a healthcare provider.
Medical Coding: Medical coding is the transformation of healthcare diagnosis, procedures, medical services, and equipment into universal medical alphanumeric codes. The diagnoses and procedure codes are taken from medical record documentation, such as transcription of physician's notes, laboratory and radiologic results, etc.
Medicaid: is a health care program that assists low-income families or individuals in paying for long-term medical and custodial care costs. Medicaid is a joint program, funded primarily by the federal government and run at the state level, where coverage may vary. (Important note: Medicaid does not cover Chiropractic services)
Medicare: Medicare is the federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD).
Modifier: a person or thing that makes partial or minor changes to something. In coding and billing, Code modifiers help further describe a procedure code without changing the definition of the code. Modifiers can be found in the CPT (Current Procedural Terminology) and HCPCS (HCFA Common Procedural Coding System) code books.
National Provider Identifier (NPI): A National Provider Identifier or NPI is a unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS).
NPI: See National Provider Identifier
Orthotics: the branch of medicine that deals with the provision and use of artificial devices such as splints and braces.
Out of network: See In-network
Personal Injury: In a narrow sense, a hurt or damage done to a man’s person, such as a cut or bruise, a broken limb, or the like, as distinguished from an injury to his property or his reputation. Typically, personal injury claims are the result of the negligence of another person. Common sources of personal injury claims include, but are not limited to, the following:
PPO plans provide more flexibility when picking a doctor or hospital. They also feature a network of providers, but there are fewer restrictions on seeing non-network providers. In addition, your PPO insurance will pay if you see a non-network provider, although it may be at a lower rate.
PTAN: Provider Transaction Access Number (PTAN) A PTAN is a Medicare-only number issued to providers by MACs (Medicare Administrative Contractors ) upon enrollment to Medicare.
Subluxation: a slight misalignment of the vertebrae, regarded in chiropractic theory as the cause of many health problems.
Tricare (styled TRICARE): formerly known as the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS), was a health care program of the United States Department of Defense Military Health System.
Workers' compensation: is a form of insurance providing wage replacement and medical benefits to employees injured in the course of employment in exchange for mandatory relinquishment of the employee's right to sue his or her employer for the tort of negligence.
Aging Report: A report used in collections and accounting that shows the money owed by insurance companies or patients. The aging report will list each patient or insurance companies’ outstanding balance and will then sort the total amount into columns such as: Current, 1-30 days past due, 31-60 days past due, 61-90 days past due, 91-120 days past due, and 120+ days past due.
AR: See “Accounts Receivable”
Balance Billing: Balance billing, sometimes also called extra billing, is the practice of a healthcare provider billing a patient for the difference between what the patient's health insurance chooses to reimburse and what the provider chooses to charge.
Bill: send a note of charges to (someone). (See “Medical Billing”)
Bundling: claims are "bundled" when a payer refuses to pay for two separate services a practice has billed. Instead, it groups, or bundles, the two charges and pays only one, smaller fee.
Business Associate Agreement: The Privacy Rule portion of the Health Insurance Portability and Accountability Act (HIPAA) of 1996 defines a "business associate (BA)" as a person or entity that performs certain functions or activities that involve the use or disclosure of protected health information (PHI) on behalf of, or provides services to, a covered entity (CE)."1 The rule requires that a covered entity obtain satisfactory assurance in writing—in the form of a contract or other agreement—from their business associates of their commitment to appropriately safeguard PHI. Such assurances safeguard the PHI obtained, created, or received on behalf of the CE in the performance of the BA's duties for the CE. The rule excludes from the definition of BAs the CE's own workforce.
Chart abstraction is the process of collecting important information from a patient's medical record and transcribing that information into discrete fields or locations within the new EHR
Claim: (v.) make a demand for (money) under the terms of an insurance policy.
In billing it is used as a noun to represent the form, electronic or paper, that makes such a demand. Example: “Did you submit his claim?”
Also sometimes used to represent the treatment and administration associated with a patient’s treatment concerning such a demand. Example: “He was treated under his Personal Injury claim today.”
Clearinghouse: Medical billing clearinghouses take claim information from a billing service or provider, check the claims for errors, and send this claim information electronically to insurance companies. Claims sent electronically are paid much faster than paper claims.
The Benefits of using a Clearinghouse are:
- Claims are sent electronically reducing postage and paper
- Reduces claim errors
- Sends claims to several different insurance payers
- Sends a large number of claims quickly
- Reduces time to get paid
Electronic Health Record: An electronic health record (EHR) is a digital version of a patient's paper chart. EHRs are real-time, patient-centered records that make information available instantly and securely to authorized users.
DME: Stands for Durable Medical Equipment
DMEPOS: Stands for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies. (See “Durable Medical Equipment” and “Orthotics”)
Durable Medical Equipment: Durable Medical Equipment (DME) is any equipment that provides therapeutic benefits to a patient in need because of certain medical conditions and/or illnesses.
EOB: See Explanation of benefits
Explanation of benefits: An explanation of benefits (commonly referred to as an EOB form) is a statement sent by a health insurance company to covered individuals explaining what medical treatments and/or services were paid for on their behalf. The EOB is commonly attached to a check or statement of electronic payment.
Flex Spending Account: A Flexible Spending Account (also known as a flexible spending arrangement) is a special account you put money into that you use to pay for certain out-of-pocket health care costs. You don't pay taxes on this money. This means you'll save an amount equal to the taxes you would have paid on the money you set aside.
Group Health Insurance: An insurance plan that provides healthcare coverage to a select group of people. Group health insurance plans are one of the major benefits offered by many employers. These plans are generally uniform in nature, offering the same benefits to all employees or members of the group.
Health Insurance: Health insurance is a type of insurance coverage that pays for medical and surgical expenses that are incurred by the insured.Health insurance can either reimburse the insured for expenses incurred from illness or injury or pay the care provider directly.
HCPCS Code (Hick-pick): HCPCS is an acronym for Healthcare Common Procedure Coding System (HCPCS). HCPCS Level II coding system is one of several code sets used by healthcare professionals, including medical coders and billers. The Level I HCPCS code set includes CPT® (Current Procedural Terminology) codes. CPT is developed and owned by the American Medical Association (AMA).
The code set is made up of five-character, alpha-numeric codes mainly representing medical supplies, durable medical goods, non-physician services, and services not represented in the Level I code set (CPT®). HCPCS Level II includes services such as ambulance, durable medical equipment, prosthetics, orthotics and supplies (DMEPOS), when used outside a physician’s office. This coding system is also used as an official code set for outpatient hospital care, chemotherapy drugs, Medicaid, and other services.
HIPAA: (Health Insurance Portability and Accountability Act of 1996) is United States legislation that provides data privacy and security provisions for safeguarding medical information.
HMO: A health maintenance organization (HMO) is an organization that provides health coverage with providers under contract. A Health Maintenance Organization (HMO) differs from traditional health insurance by the contracts it has with its providers.
An HMO gives you access to certain doctors and hospitals within its network. A network is made up of providers that have agreed to lower their rates for plan members and also meet quality standards. But unlike other insurance plan types, care is covered only if you see a provider within that HMO’s network. There are few opportunities to see a non-network provider. There are also typically more restrictions for coverage than other plans, such as allowing only a certain number of visits, tests or treatments.
HSA (Health Savings Account): A health savings account (HSA) is a tax-advantaged medical savings account available to taxpayers in the United States who are enrolled in a high-deductible health plan (HDHP). The funds contributed to an account are not subject to federal income tax at the time of deposit.
ICD-9 Codes: The International Classification of Diseases, Ninth Revision. The international standard list of six-character alphanumeric codes to describe diagnoses.
ICD-9-CM: The International Classification of Diseases, Ninth Revision, Clinical Modification. The U.S. health system's adaptation of international ICD-9 standard list of six-character alphanumeric codes to describe diagnoses. ICD-9-CM contains a list of codes corresponding to diagnoses and procedures recorded in conjunction with hospital care in the United States. These codes may be entered onto a patient's electronic health record and used for diagnostic, billing and reporting purposes. Related information also classified and codified in the system includes symptoms, patient complaints, causes of injury, and mental disorders.
ICD-10-CM: The International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) is a system used by physicians and other healthcare providers to classify and code all diagnoses, symptoms and procedures recorded in conjunction with hospital care in the United States. The ICD-10-CM revision includes more than 68,000 diagnostic codes, compared to 13,000 in ICD-9-CM. In addition, ICD-10-CM codes include twice as many categories. ICD-10-CM diagnosis codes consist of three to seven digits, compared to the three to five digit system of ICD-9-CM. The increase in the amount and length of ICD-10-CM codes will allow for greater coding specificity.
Incident to: "Incident to" services are defined as services or supplies furnished as an integral, although incidental, part of the physician's personal professional services in the course of diagnosis or treatment of an injury or illness. Reimbursement. Reimbursement is based on 100% of the physician fee schedule amount.
In-network: A health insurance provider network is a group of health care providers that have contracted with an HMO or PPO to provide care at a discount. “In-network” refers to a provider who has signed a contract to be in such network.
An in-network provider contracts to accept a lower fee is not allowed to “balance bill” a patient. A provider who is not contracted to be in-network, is “out of network”, and may balance bill. (See “balance billing”)
Medical Billing: Medical billing is the process of submitting and following up on claims with health insurance companies in order to receive payment for services rendered by a healthcare provider.
Medical Coding: Medical coding is the transformation of healthcare diagnosis, procedures, medical services, and equipment into universal medical alphanumeric codes. The diagnoses and procedure codes are taken from medical record documentation, such as transcription of physician's notes, laboratory and radiologic results, etc.
Medicaid: is a health care program that assists low-income families or individuals in paying for long-term medical and custodial care costs. Medicaid is a joint program, funded primarily by the federal government and run at the state level, where coverage may vary. (Important note: Medicaid does not cover Chiropractic services)
Medicare: Medicare is the federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD).
Modifier: a person or thing that makes partial or minor changes to something. In coding and billing, Code modifiers help further describe a procedure code without changing the definition of the code. Modifiers can be found in the CPT (Current Procedural Terminology) and HCPCS (HCFA Common Procedural Coding System) code books.
National Provider Identifier (NPI): A National Provider Identifier or NPI is a unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS).
NPI: See National Provider Identifier
Orthotics: the branch of medicine that deals with the provision and use of artificial devices such as splints and braces.
Out of network: See In-network
Personal Injury: In a narrow sense, a hurt or damage done to a man’s person, such as a cut or bruise, a broken limb, or the like, as distinguished from an injury to his property or his reputation. Typically, personal injury claims are the result of the negligence of another person. Common sources of personal injury claims include, but are not limited to, the following:
- Automobile accidents
- Pedestrian accidents
- Defective product claims
- Medical malpractice
- Slip and fall claims
PPO plans provide more flexibility when picking a doctor or hospital. They also feature a network of providers, but there are fewer restrictions on seeing non-network providers. In addition, your PPO insurance will pay if you see a non-network provider, although it may be at a lower rate.
PTAN: Provider Transaction Access Number (PTAN) A PTAN is a Medicare-only number issued to providers by MACs (Medicare Administrative Contractors ) upon enrollment to Medicare.
Subluxation: a slight misalignment of the vertebrae, regarded in chiropractic theory as the cause of many health problems.
Tricare (styled TRICARE): formerly known as the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS), was a health care program of the United States Department of Defense Military Health System.
Workers' compensation: is a form of insurance providing wage replacement and medical benefits to employees injured in the course of employment in exchange for mandatory relinquishment of the employee's right to sue his or her employer for the tort of negligence.