There are many terms involved in medical billing and coding, but some very important and significant ones help to provide an underlying structure to the relationship between hospitals and care facilities, physicians, insurers, and the professionals who do the work of medical billing and coding. Knowing the terms often used in "keeping the record straight" in medical billing and coding will definitely help a business involved in any aspect of this important work.
What is known in the medical business as HIPAA, or the Health Insurance Portability and Accountability Act, governs much of how information is handled in any medical office or facility, or in any role during a medical career.
U.S. Dept. of Health and Human Services
An ICD-9 or ICD-10 code is a modern way to refer to a clinical diagnosis in medical billing and coding. The ICD system is an international way to standardize diagnosis on paper and facilitate good understanding for anyone who may use a medical record or chart.
HHS Centers for Medicare and MedicAid Service
Two other types of medical codes center not on diagnosis but on specific procedures. These codes also have a big impact on insurance results and are often called "reimbursement codes." The technical names are Healthcare Common Procedure Coding System (HCPCS) and Current Procedural Terminology (CPT).
Place of Service codes
Another big aspect of medical coding and billing is making sense of Place of Service codes, which are reported at specific points on a claim form or other medical document.
An EOB, or Explanation of Benefits, is what a health insurer may send a member. This form gets a lot of use by medical billing and coding professionals who are involved in making sure everything on a form is correctly reported.
An insurer, and therefore a medical biller or coder, will also generally measure what's called "medical necessity." This term is a way of explaining how a company, care provider or insurer measures whether the claim will be covered according to whether the patient needed the specific care or procedures defined.