In this blog series we are looking at important terms in the medical billing and coding industry. We believe that being informed about the business is the best way to start making improvement, and we are all about efficiency at M-Scribe. This installment will be focused on terms that begin with the letters N and O.

National Center For Health Statistics (NCHS)

The National Center for Health Statistics is a federal agency under the CDC (Center for Disease Control) responsible for providing statistical information related to the health of the American people. This agency is responsible for designating the International Classification of Disease (ICD) codes in the United States, which are the mandated means for coding disease diagnoses.

National Provider Number (NPI)

A unique 10-digit number assigned to medical service providers in the United States, per the requirements of Health Insurance Portability and Accountability Act of 1996 (HIPAA). These numbers are maintained by the Department of Health and Human Services in the NPI Registry.

Network Provider

A medical service provider which has contracted with an insurance company to provide specified services at established rates.

Non-Covered Charge (N/C)

Any medical service which is not covered by the patient’s insurance plan. Typically, the patient will pay the full amount for these charges.

Non-Participating Provider (Non-Par)

A medical service provider which is not currently in a contractual relationship with the insurance company. Also sometimes called Out-of-Network or non-contracted. Non-Pars may or may not make insurance claims. When billing insurance, they will typically require higher copays and receive less of their fee from insurance companies.

Not Elsewhere Classifiable (NEC)

Code used for a medical diagnosis when there is no International Classification of Disease (ICD) Code available for the disease, although the disease has been clearly identified.

Not Otherwise Specified (NOS)

Code used when the documented diagnosis does not provide sufficient information to determine the appropriate International Classification of Disease (ICD) Code, if any. NOS Codes can present difficulties if being audited and should be clarified as soon as possible.

Office of Inspector General (OIG)

Enforces the mandates of the Department of Health and Human Services by periodically inspecting and monitoring medical service providers in the United States. Essentially, the OIG acts as the police arm for Health and Human Services.

Out of Network (OON)

When a patient chooses to go to a Non-Par (Non-Participating Provider) for services. Generally, the patient will have to pay more for the services provided, if they are covered at all.

Out of Pocket (OOP)

The amount a patient is required to pay for medical services which are covered by insurance, such as co-payments, co-insurance, and deductibles.

Outpatient

Medical services provided to a patient outside of a long-term hospital stay, either in a doctor’s office or other clinic, or by means of an outpatient visit to a hospital with no overnight (24-hour or more) stay.

Hopefully this series is helping you better understand the jargon in the industry. If you don’t understand something or simply have any questions for our teams of industry experts or for more information on outsourced medical billing and how M-Scribe can help your business, please feel free to contact us at any time.

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