Lingo
WC
Worker's Compensation
WO
Write off, or adjustment
XR
Xray
Clearinghouse
a central data bank used for the purpose of submitting and error checking electronic insurance claims
CMS 1500 claim form
a universal billing form used and accepted by most insurance carriers nationwide to make a claim for benefits
CPT codes are published _____ and owned by the _____.
annually American Medical Association
Carrier
another word for insurer, payer or insurance company
Allowed Charge can also be called ______.
approved charge
PRN
as needed
Beneficiary is sometimes referred to as a ______.
claimant
Q
every
QD
every day
QAM
every morning
QID
four times per day
IP
inpatient hospital
Part B Medicare covers
physician services
A location code is also called a ______ code.
place of service
Elb
Elbow
ECP
Electronic Claims Processing
EDI
Electronic Data Interchange
EFT
Electronic Funds Transfer
EMC
Electronic Media Claims
ER
Emergency room
ESRD
End stage renal disease
EH
Essential Hypertention
Eval
Evaluation
E & M
Evaluation and Management
EX
Excision
EOMB
Explanation of Medicare Benef
EOB
Explanation of benefits
Ext
Exterior
Patient information sheet
A form, completed by a patient that contains personal demographic information such as social security number, date of birth, address and insurance information
Medicaid
A government health insurance program for poor and medically indigent patients
Global Service
A group of related services that are included as a single unit of service for the purpose of coding, billing and payment
Fee Schedule
A list of predetermined prices or payments for medical services
Fee-for-Service
A method where a provider charges a fee for each service he renders
Crossover Claim
A patient who has both Medicare and Medicaid coverage
Inpatient
A person who is confined to the hospital for more than a set number of hours which is determined by the insurance carrier
Participating
A physician who signs an agreement accepting assignment on all claims
FU
Follow up
Ft
Foot
FX
Fracture
GP
General Practitioner
GYN
Gynecology
HIPAA
Health Insurance Portability and Accountability Act
HMO
Health Maintenance Organization
Managed care
Health care delivery management designed to control health care costs and improve utilization of services
MediGap Insurance
Health insurance provided by private carriers that cover medicare deductibles and coinsurance amounts
HCFA
Healthcare Financing Administration
HBP
High Blood Pressure
IH
Inpatient Hospital
Ins
Insurance or insured
ICD10CM
International Classification of Diseases, 10th revision, Clinical Modification
IBS
Irritable Bowel Syndrome
IHD
Iscemic heart disease
Jt
Joint
Kn
Knee
LMP
Last menstrual period
LT
Left
LL
Left Leg
LA
Left arm
LF
Left foot
LS
Left side Lumbar Strain Sprain
LUQ
Left upper quadrant
LCSW
Licensed Clinical Social Worker
LOC
Location
LBP
Low back pain
LLQ
Lower left quadrant
LRQ
Lower right quadrant
L
Lumber
SOB
Shortness of breath
Sh
Shoulder
SRG
Surgery
TIN
Tax ID#
Diagnosis
The determination of the disease, condition or illness of a patient
Primary carrier
The insurance carrier that pays primary insurance benefits
Secondary Carrier
The insurance carrier that pays second
Release of Information
The patient's signature indicating consent to the realse of information necessary for settlement of the insurance claim
Dependent
The spouse and or children of the insured person
UA
Urinalysis
UTI
Urinary tract infection
U & C
Usual & Customary
Pending claim
A claim that has been submitted, but on which final denial or payment action has not been taken by the carrier
Medicare
A federal health insurance program for retired and disabled persons.
Copayment
A fixed dollar amount an insured person must pay the provider at the time of an office visit
Superbill
A form that lists basic information, the actual service rendered, and the diagnosis of the patient
Generally, ____ hours or more is considered inpatient.
12
A good example of coinsurance would be an ______split
80-20
UB04
A universal billing form used to submit hospital charges
Diagnosis code
A universal code that describes and illness, injury or disease
Location code
A universal code that is used on a CMS 1500 claim form to report the actual location where services were rendered
Part A Medicare
A voluntary entitlement program that covers hospital charges
ACC
Accident
ASU
Ambulatory Surgical Unit
Deductible
An amount that a covered person must pay before benefits are paid by the insurer
Intermediary
An insurance carrier that administers Medicare part A claims and benefits for the government.
BCBS
Blue Cross & Blue Shield
Exclusions
Certain services or conditions that insurance carriers will not cover; or services or conditions that are covered at a limited rate
Cont
Contusion
DX
Diagnosis
OD
Doctor of Opthalmalogy
ENT
Ear, nose and throat
EPSDT
Early periodic screening and detection treatment
HX
History
H & P
History & Physical Exam
I & D
Incision and drainage
Inel
Ineligible
GAP
MediGap
MD
Medical Doctor
MEOB
Medicare Explanation of benefits
MSP
Medicare Secondary Payor
MSN
Medicare Summary Notice
MFS
Medicare fee schedule
NPI
National Provider ID
NSF
National Standard Format
NonPar
Non participating provider
OV
Office visit
OR
Operating room
OP
Outpatient
PAR
Participating provider
PID
Pelvic inflamatory disease
PI
Personal Injury
PT
Physical Therapy or Patient
PA
Physician's Assistant
POS
Place of service
PPO
Preferred Provider Organization
PC
Professional Counselor
Evaluation and Management Services
Professional services provided by physicians and healthcare providers for the purpose of diagnosing and treating diseases and illnesses
PIN
Provider ID#
Psy
Psychiatry
PD
Pulmonary Disease
ROM
Range of Motion
RAD
Reactive airway disease
R & C
Reasonable and Customary
RBRVS
Resource Based Relative Value Scale
Rt
Right
RA
Right Arm
RL
Right Leg
RUQ
Right Upper Quadrant
OS
Right eye
RF
Right foot
RU
Right upper
SI
Sacroiliac
SSOP
Second Surgical Opinion
TPA
Third party administrator
T
Thoracic
Tx
Treatment
TOS
Type of Service
UPIN
Unique physician identification number
UB92
Universal Billing Form, revised 1992
Modifiers
Universal codes used to supplement HCPCS and CPT codes to indicate that the service has been changed in some way from the exact code description
U
Upper
UH
Upper half
URI
Upper respiratory illness
WDWN
Well developed well nourished
Assignment of Benefits
When an insured person authorizes the carrier to make payment of allowable benefits directly to the provider
CPT codes describe a _____ or _____.
service, procedure
Beneficiary
simply put is the "insured person"
Premium charges are withheld from _______when a patient is enrolled in Medicare Part B.
social security checks
Allowed Charge
the amount a carrier approves for payment
Benefit
the amount payable by an insurer
Accept Assignment
the doctor agrees to accept the insurance carrier's approved amount as payment in full
Coinsurance
the portion of the balance of covered medical expenses that an insured person must pay the provider after the insurance carrier pays
TD
three times a day
