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Medical Billing and Coding Terminology You Should Know: F & G

February 24, 2015

Medical Billing Terminology 
This latest installment in our blog series continues our exploration of the most important medical billing and coding industry terminology you should know. Since good communication helps foster good business, it is extremely important you always know what your team members are saying. These terms beginning with the letters “f” and “g” consist of a combination of vocabulary words and important acronyms. Here are the most important terms you need to know.

Fair Credit Reporting Act: 

A federal law that regulates how consumer credit information may be collected and used.

Fair Debt Collection Practices Act (FDCPA): 

Another federal law that regulates the way creditors and collections agencies operate when attempting to secure payment for past due invoices.

Fee-For-Service (FFS): 

A type of insurance in which the medical provider is paid for each procedure or service he or she provides. This type of insurance typically allows the patient to choose his or her own provider, and also tends to come with higher deductibles and co-pays.

Fee Schedule: 

Refers to the exact cost associated with each CPT billing code for a particular provider.

Financial Responsibility: 

The amount or percentage of medical bills payable by the patient or insured party.

Fiscal Intermediary (FI): 

A person that process Medicare claims who is also a Medicare representative.

Formulary: 

A list of prescription medications and their associated costs developed by an insurance company for the purpose of determining payment. Insurance companies usually reimburse only for medications that are included on their formulary list.

Fraud: 

Any act by a provider or patient that uses dishonest or misleading means to obtain treatment or reimbursement for services. Fraud is a criminal act that is punishable by fines and jail time, and can even result in the loss of a medical license.

Group Health Plan (GHP): 

A plan administered by an employer for the purpose of providing health care benefits to their employees (or former employees) and their family members.

Group Name: 

This is the name of the insurance plan or group plan that a patient is covered under, and is listed on the insurance card. This is different from the name of the insured, which is usually listed on the insurance card as well.

Group Number:

A number assigned by a medical insurance company that identifies the group to which the patient belongs. This number helps to identify the patient and verify eligibility or coverage.

Guarantor: 

A responsible person and/or insured party who is not actually the patient.

 

Keeping up with these terms is important if you are to perform your medical billing and coding functions correctly. New terms are constantly being added all the time, which is why you should make an ongoing effort to stay up to date with the latest ones. You can also contact us to ensure you are always in compliance so you won’t have to worry about learning new terms.

 

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