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Medical Billing and Coding Terminology You Should Know: C

February 10, 2015

Medical Billing Terminology 
Earlier this week, we discussed some key medical billing and coding terms beginning with the letter “C”. This list is not all-inclusive, as there are actually too many terms to include in only one blog post, so today we are focusing on all the C-terms. Here are some additional medical billing and coding terminology everyone in the industry should know:

1. Co-Insurance-

Refers to the amount or percentage that the patient is responsible for. For example, in a 90/10 plan, the patient’s co-insurance rate is 10% and the remaining 90% is paid by the carrier.

2. Collection Ratio-

In accounts receivable, the collection ratio refers to the amount of payments received in comparison to the amount of money owed on a particular account.

3. Conditional Payment- 

A Medicare payment that another insurance company is primarily responsible for.

4. Consolidated Omnibus Budget Reconciliation Act (COBRA)-

Federal law that allows a worker to continue purchasing employer-provided health coverage for up to 18 months after a job loss or other event that results in lost coverage.

5. Contracted Provider –

A physician, physician’s assistant or Advanced Registered Nurse Practitioner (ARNP) that has contracted with an individual’s health insurance company.

6. Contractual Adjustment –

Charges that a provider agrees to write off rather than charge to the patient in accordance with their contract with the insurance carrier.

7. Coordination of Benefits (COB)-

When patients are covered by more than one insurance plan, a coordination of benefits is used to determine which one is primary and which one is secondary.

8. Copay-

The amount of money a covered patient is required to pay for each office visit. This amount is determined by the insurance company, and is not generally included as part of the deductible amount.

9. Covered Service-

Benefits that are allowable based on a physician’s contract with an insurance company, to include Medicaid, Medicare and worker’s compensation.

10. Credentialing-

This refers to an application process used by medical providers when partnering with insurance companies. CAQH credentialing is one form of this process, and is universally accepted by many insurance carriers.

11. Credit Balance-

Occurs whenever more money has been paid on a patient’s account than what he or she owes, resulting in the need for a refund. It is denoted on a ledger by placing the amount due in parentheses.

12. Crossover Claim-

Whenever a patient who is eligible for both Medicaid and Medicare receives healthcare services that are covered by both programs, the crossover claims process is used to ensure the claim is not paid twice.

13. Current Procedural Terminology (CPT)-

A list of procedure codes that are copyrighted by the American Medical Association (AMA). These codes are used to describe the procedure(s) used to treat a patient.


These terms are important ones to know if you are to ensure accurate claims and a speedy paymenty. If you have questions about other terminology or medical billing issues, please feel free to contact us at any time.


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