Acronyms, Codes, Terminology: The Language of Medical Billing

Knowing all the Medical Billing services that keep your billing bases covered, and the correct acronyms and codes that identify procedures and facilities, are a significant part of making sure your revenue cycle is being managed efficiently, and your claims are will get paid by the insurance companies.🔗

Prime among the many elements that make up a clean claim (one that is accepted for payment by the insurance company), are the codes that correspond to the procedures and diagnoses on the claim, and define the charges paid to providers.

While the Health Insurance Portability and Accountability Act (HIPAA) requires the use of uniform billing codes, or Current Procedural Terminology (CPT®) codes, for all healthcare electronic transactions, not all procedures align with CPT codes. If a CPT code doesn’t exist for a particular diagnosis or procedure, the coder must use the appropriate unlisted code, the Not Otherwise Classified (NOC) code (which often ends in 99, which means there are a lot of them).

It’s really important to know all the terminology relevant to Medical Billing in Texas, Illinois, Michigan and other states, and stay current with the hundreds of acronyms and constantly updating procedure codes that ensure clean claims, mitigate compliance exposure, and avoid time-consuming denials.

Medical Billing Terminology and Acronyms🔗

Here are just a few of them:🔗

RCM🔗

Revenue Cycle Management (the process by which a healthcare organization submits and receives payment for medical services performed)

RCM Systems & Software🔗

PM🔗

Practice Management

PMS🔗

Practice Management Systems

EMR🔗

Electronic Medical Record: contains the medical and treatment history of the patients in one practice

EHR🔗

Electronic Health Records: similar to an EMR but focuses on the total health of a patient—going beyond standard clinical data collected in the provider’s office

CVO🔗

Central Verification Office (they do privileging)

RCM Services & Support🔗

Provider Credentialing🔗

The process by which a healthcare provider’s qualifications are supplied to and verified by an insurance carrier (payer) in order for the provider to be enrolled in their system, and able to receive payment.

Provider Privileging🔗

The process by which a healthcare provider’s qualifications are supplied to and verified by an insurance carrier (payer) in order for the provider to be enrolled in their system, and able to receive payment.

CVO🔗

Central Verification Office (they do privileging)

BDR🔗

Business Development Representative

Medical Billing Codes🔗

ASC🔗

Ambulatory Surgery Center

ATD🔗

Applied to Deductible

AOB🔗

Assignment of Benefits

CARC/RARC🔗

Claim Adjustment Reason Code/Remittance Advice Remark Code

CO🔗

Contractual Obligation

CR🔗

Corrections and Reversal

OA🔗

Other Adjustment

PI🔗

Payer Initiated Reductions

PR🔗

Patient Responsibility

COB🔗

Coordination of Benefits

CPT🔗

Current Procedural Technology

HCPCS🔗

Healthcare Common Procedure Coding System

Level I CPT-4 Codes🔗

For medical services and procedures

• Evaluation & Management (99202–99499)
• Anesthesia (00100–01999)
• Surgery (10021–69990) — further broken into smaller groups by body area or system within this code range.
• Radiology Procedures (70010–79999)
• Pathology and Laboratory Procedures (80047–89398)

Level II CPT-4 Codes🔗

Products, supplies and services not otherwise included (ambulance services, and durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) when used outside a physician’s office.

DME🔗

prosthetics, orthotics or supplies used outside a doctor’s office

Medical billing is a professional-grade job that requires the expertise and experience of highly-trained medical billers and coders, who maintain current industry-standard coding proficiency and best practices.

Every coder on the Medusind Coding Services team is trained at the Medusind Coding Center of Excellence. They are 100% CPC-Certified and maintain an AAPC, AHIMA, or multiple certifications. Medusind coders are exclusive to Medusind clients, optimizing customer support and accountability.

Find out more about Medical Billing and Coding Services, and the Medusind Coding Center of Excellence that ensures the highest level of coding skills, helps generate consistently clean claims, and provides each client with an unmatched level of customer support.