The world of medical billing and coding is complicated, and often abbreviations are used to save time and effort. Of course, this only actually saves time and effort if you know what they stand for afterward! Each healthcare facility will have its own most frequently used acronyms based on its area of expertise; but here are some of the most commonly used medical billing codesacross all medical offices:
CMS (Centers for Medicare & Medicaid Services): The division of the United States Department of Health and Human Services that administers Medicare, Medicaid, and the Children’s Health Insurance Program.
HIPAA (Health Insurance Portability and Accountability Act): You won’t go very long in healthcare without hearing about HIPAA. This law dictates patient privacy and outlines how certain entities like health plans or clearinghouses can use or disclose personal health information.
EOB (Explanation of Benefits). This document is issued by the insurance company in response to a claim submission and it outlines what services are covered (or not) and at what level of reimbursement.
HMO (Health Maintenance Organization): This is another one used quite often across the board. This refers to an insurance plan that requires the patient use a primary care physician who acts as a “gatekeeper.” In HMOs, patients much seek treatment from the primary physician first, who, if she feels the situation warrants it, can refer the patient to a specialist within the network.
POS (Point of Service): A health insurance plan that offers the low cost of HMOs if the patient sees only network providers.
INN (in-network): This refers to a provider who has a contract with either the insurance company or the network with whom the payer participates.
OON (out-of-network): An out-of-network provider is one who does not have a contract with the patient’s insurance company.
PPO (Preferred Provider Organization): A health management plan that allows patients to visit any providers contracted with their insurance companies. If the patient visits a non-contracted provider, the claim is considered OON.
EDI (Electronic Data Interchange): The electronic systems that carry claims to a central clearinghouse for distribution to individual carriers.
WC (Workers’ Compensation): This is the U.S. Department of Labor program that ensures employees who are injured at work and ensures they receive treatment. This is used around the office either in response to injuries at the healthcare facility or patients being treated for work-related issues.
This can definitely seem overwhelming, especially if sending the billing is not your full-time job. Who can possibly keep all of these straight? Bring in Aptus! We can help you with your medical billing, so you can focus on what’s important- your patients.