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@tamaralapoggi1:
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Monday 02 January 2023 21:46:06 GMT
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lessons 2 Medical Billing & Coding Terms Listed below are the more common terms, abbreviations, and acronyms used in medical billing and coding. Common Abbreviations and Acronyms AOB – Assignment of benefits AMA – American Medical Association BCBS – Blue Cross Blue Shield CMS – Centers for Medicare and Medicaid Services CPT– Current Procedural Terminology. The 5 digit code assigned a procedure performed by the physician DME – Durable Medical Equipment DOS – Date of Service Dx – Abbreviation for diagnosis code EMR – Electronic Medical Records EOB – Explanation of Benefits ERA – Electronic Remittance Advice E/M – Evaluation and Management section of the CPT codes HCPCS – Health Care Financing Administration Common Procedure Coding System (pronounced “hick-picks”) HIPAA – Health Insurance Portability and Accountability Act ICD – International Classification of Diseases NOS – Not Otherwise Specified NPI – National Provider Identifier PHI – Protected Health Information POS – Place of Service RVU – Relative Value Units SOF – Signature on File Common Medical Billing and Coding Terminology Accept Assignment – When a healthcare provider accepts as full payment the amount paid on a claim by the insurance company. This excludes patient responsible amounts such as coinsurance or copay. Adjusted Claim – When a claim is corrected which results in a credit or payment to the provider. Allowed Amount – The reimbursement amount an insurance company will pay for a healthcare procedure. This amount varies depending on the patients insurance plan. For 80/20 insurance, the provider accepts 80% of the allowed amount and the patient pays the remaining 20%. Aging – One of the medical billing terms referring to the unpaid insurance claims or patient balances that are due past 30 days. Most medical billing software’s have the ability to generate a separate report for insurance aging and patient aging. These reports typically list balances by 30, 60, 90, and 120 day increments. Ancillary Services – These are typically services a patient requires in a hospital setting that are in addition to room and board accommodations – such as surgery, lab tests, counseling, therapy, etc. Appeal – When an insurance plan does not pay for treatment, an appeal (either by the provider or patient) is the process of objecting this decision. The insurer may require documentation when processing an appeal and typically has a formal policy or process established for submitting an appeal. Many times the process and associated forms can be found on the insurance providers web site. Applied to Deductible (ATD) – You typically see these medical billing terms on the patient statement. This is the amount of the charges, determined by the patients insurance plan, the patient owes the provider. Many plans have a maximum annual deductible that once met is then covered by the insurance provider. Assignment of Benefits(AOB) – Insurance payments that are paid directly to the doctor or hospital for a patients treatment. This is designated in Box 27 of the CMS-1500 claim form. Authorization – When a patient requires permission (or authorization) from the insurance company before receiving certain treatments or services. Beneficiary – Person or persons covered by the health insurance plan and eligible to receive benefits. Blue Cross Blue Shield (BCBS) – An organization of affiliated insurance companies (approximately 450), independent of the association (and each other), that offer insurance plans within local regions under one or both of the association’s brands (Blue Cross or Blue Shield). Many local BCBS associations are non-profit BCBS sometimes acts as administrators of Medicare in many states or regions. Capitation – A fixed payment paid per patient enrolled over a defined period of time, paid to a health plan or provider. This covers the costs associated with the patients health care services. This payment is not affe#milaad #BillingAndCoding #islamabad #medical #islamabad
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