Common Medical Billing and Coding Terminology

Article Written By: DeborahDera

Entering the medical billing and coding field will require that you learn a long list of varied terminology. It is the basis of the career that is an intricate, extremely important aspect which can mean the difference between a client or patient being billed correctly or having them end up in a quagmire of mistaken finances.

In the beginning, educating yourself on the common medical billing and coding terminology will enable you to be one step ahead of other students. There are literally hundreds of terms to memorize, below is an example of some of the more general expressions and abbreviations used.

Common Terminology

Ambulatory Care – Health service that does not require an overnight stay.

Ancillary Service – Services billed beyond room and board such as surgery, lab tests and therapy.

ABN – Advanced beneficiary notice

Assignment of Benefits – Insurance payment sent directly to the hospital or physician.

Beneficiary – Person covered by health insurance.

CHAMPUS – Military health insurance also called TriCare.

Clean Claim – Claims that need not be investigated by insurance before processing.

COBRA – Insurance purchased by an individual when employment is terminated.

Coordination of Benefits (COB) – Determining which insurance company pays when more than one company covers a patient.

CPT Codes – Description of services and treatments.

DOS – Date of service when a patient is treated.

Diagnosis Code – code for billing illness.

DME – Durable medical equipment that can be used many times or at home.

EEG – Measuring electricity in the brain.

EKG/ECG – Measurement of heart function.

EOB/EOMB – Explanation of benefits.

FI – Fiscal intermediary, Medicare personnel that processes claims.

Guarantor – A person who agrees to cover the bill.

HCFA 1500 Billing Form (CMS) – Doctor s for filing claims.

HCPC Codes – Describes treatment and services administered by the doctor.

HMO – Health maintenance organization of specific insurance providers.

IP – In-patient who stays overnight.

ICN – Internal control number for assigned billing.

LTC – Long term care.

MSN – Medicare summary notice.

Medigap – Medicare supplement insurance.

MRI – Magnetic resonance imaging, a type of x-ray.

Non-Participant Provider – Doctor, hospital or insurance not part of the network.

Oncology –Cancer related services.

OP - Outpatient

PPS – Federal prospective payment system that pays a fixed rate.

POS – Place of service or Point of service.

Per-Diem – Charged by the day.

PCN – Primary care network.

PPS – Prospective payment service, set amount paid by Medicare.

RA – Remittance advice

R and C – Reasonable and customary.

SDS – Same day surgery.

Submitter ID – Doctor or hospital ID number.

TOS – Terms of Service

UB-92 – Insurance form for medical claims.

UR – Utilization review, staff that helps to gain lower cost care.

These common terms are a good start in getting familiar with the industry. However, medical billing and coding terminology is constantly changing so it is a good idea to stay educated throughout your career.

About the Author

Deborah Dera is currently focused on medical billing and coding as well as other administrative support roles throughout the industry.

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