Part of being a successful medical billing and coding specialist involves being familiar with the terminology used in this profession. In this post of our multi-part blog series, we’ll look at common terms that fall toward the end of the alphabet. And with this post, our viewers finally have the list of all the most important industry terms you should know. Here are the medical billing and coding terms you should know.
This is a claim form used by hospitals and medical clinics who are charging facility fees. This form replaces the UB92 form.
This refers to the process of submitting multiple CPT treatment codes whenever it is only necessary to submit one.
Unique Physician Identification Number (UPIN) –
This is a unique six-digit code assigned to each physician by the Center for Medicare and Medicaid Services (CMS). The UPIN code was actually discontinued in 2007, and has since been replaced by an NPI number.
Untimely Submission –
This refers to a claim that was submitted after the insurer’s allowable timeframe. When an untimely submission occurs, it results in a denial.
The practice of using an ICD-9 code that does not coincide with the actual treatment. This is sometimes done in an effort to increase the amount of payment received from an insurance company, and is illegal.
Usual, Customary and Reasonable (UCR) –
Insurance companies have a fee schedule that determines the maximum amount they will pay for a particular service. The allowable coverage is based on what is considered “usual, customary and reasonable” for that geographic location.
Utilization Limit –
The limits set by Medicare as to how many times a service can be provided within a one-year timeframe. If the utilization limit is reached, the patient’s claim could be denied.
Utilization Review (UR) –
An audit or review that is performed to reduce or eliminate what are deemed to be unnecessary medical procedures or services for patients.
In the ICD-9 coding system, V-codes are a classification used to identify health care that is performed for reasons other than illness or injury.
Workers Compensation (WC) –
A type of insurance claim that arises whenever an employee suffers a work-related or on-the-job illness or injury.
Many insurance plans have limits as to what they will pay. These amounts are typically not transferrable to the patient, which means they must be “written off” as not chargeable. They are sometimes known as “not covered” expenses.
These codes are similar to V-codes in that they are also used to describe instances whereby patients receive care that is not due to an illness or injury. An example could be a routine checkup.
Keeping up with these terms doesn’t have to be difficult. Review the previous posts to learn all the industry terms you should know. Please feel free to contact us for all your medical billing and coding needs, and you can be sure your work is handled by someone who is knowledgeable and will help you increase your bottom line.