Part of being a successful billing and coding specialist involves being familiar with the terminology used in the industry. After all, your billing and coding needs can’t be met if you don’t know what is being discussed. Luckily for you, we have put together a vast glossary of industry-specific terms that you need to familiarize yourself with.
Our later posts will cover the rest of the alphabet, but we will begin with letters A and B today:
1. Adjusted Claim –
A claim may require adjustment. It could result in an additional payment to the provider or a credit.
2. Advanced Beneficiary Notice (ABN) –
This refers to a notice given when the provider of medical services or items sometimes covered by Medicare believes that in a specific case, they may not be covered. It should include the reason coverage may be denied for the item or service. It is not required if Medicare never covers the item. It is sometimes known as a waiver of liability.
3. Affordable Care Act (ACA) –
Occasionally, this is called Obama Care. It protects the patient’s right to choice of physician and allows them to appeal claim denials. It also removes lifetime care maximums and protects the patient from arbitrary withdraws of insurance coverage.
4. Allowed or Allowable –
The allowed amount to charge for a specific procedure or item is something negotiated in your contract with the insurance company. You can never charge a higher total, including amount paid by the insurance and amount paid by the patient, than the allowed amount.
5. American Medical Association (AMA) –
This is the largest group of doctors and medical students in the United States. They also publish one of the most widely read medical journals.
6. Ancillary Services –
This refers to the services that a patient requires in a hospital setting in addition to room and board. These include but are not limited to surgery, counseling, and lab testing.
7. Appeal –
If an insurance company denies payment on a claim, the patient or provider can request that they look at the claim again. Each insurance company has their own process to handle the appeal process but it typically requires additional documentation to be given to the insurance company.
8. Application Service Provider (ASP) –
An application service provider keeps the program on their own servers. The information can typically be accessed through a web browser or a custom interface on the client’s computer. This improves reliability and availability while avoiding integration issues at the client sites. Typically you can pay per use or per month instead of needing to purchase the software outright.
9. Applied to Deductible (ATD) –
These are charges that the patient owes the medical provider when their deductible still needs to be met for the benefit year.
10. Any Willing Provider (AWP) Laws –
These laws require insurance companies in the state to accept any qualified provider who is willing to accept the terms of the managed care plan. That doesn’t require them to take all providers. Usually they have processes in place to evaluate providers to see if they’re qualified based on the insurance company’s criteria. These laws are state specific and not all states have a version of them.
11. Assignment of Benefits (AOB) –
These payments from an insurance company are paid directly to the doctor or hospital.
12. Balance Bill –
This happens when the provider bills the patient for the difference between the usual charge and the amount allowed by the insurance company. Some states or insurances prohibit balance billing and require that the doctor or hospital not ever receive a combination of payments for a specific service that is higher than the allowed amount.
13. Beneficiary –
The beneficiary of a policy is the person or people who are covered.
14. Blue Cross Blue Shield (BCBS) –
This is an organization of affiliated providers who supply independent coverage within their local region under one or both of the brands. In some regions, they act as administrators for Medicare.
Outsourcing to M-Scribe can be the solution for coding mistakes that can keep your practice from getting paid. Please feel free to contact us for assistance with any medical billing needs.