Skip to main content

Acquaint Yourself Further with Medical Billing -Avontix


In our previous article, we have already understood that to catch the medical billing nuances fast it is very helpful if the terms that are commonly used in the medical billing jobs are understood first. As a continuation of our efforts to understand the various medical billing terms, in this article, we shall see some more terms that are commonly used in the medical billing industry.
Fiscal Intermediary – Fiscal Intermediary (FI) is a Medicare representative who processes Medicare claims.

Guarantor – Guarantor is a party that pays for an insurance plan of a patient but he himself is not a patient.

HCPCS – Healthcare Financing Administration Common Procedure Coding System (HCPCS) is a coding system to explain the various services, treatment and devices used in providing healthcare. These codes are commonly used by medical billers to file health insurance claims.

Healthcare Provider – Entities that provide healthcare services to patients like hospitals, physicians, clinics, nursing homes and all healthcare facilities are called healthcare providers.

Hospice – Hospice is medical care and treatment for inpatient, outpatient or home healthcare for terminally ill patients.

ICD-10 Codes - International Classification of Diseases codes are set of codes that are used to represent the diagnoses of patient medical conditions. These codes consist of 3 to 7 digits.

Managed Care Plan - This is a health insurance plan in which patients are required to consult doctors or hospitals that operate in the insurance company’s network only to receive coverage.

Medical Coder – A medical coder is one who is in the medical coding jobs and assigns different medical codes to the services provided by the healthcare facilities.

Medical Billing Specialist - A medical billing specialist processes insurance claims to receive payments for services rendered by a healthcare facility. Professionals in medical billing jobs ensure that the codes and all other critical information entered in the insurance claims are accurate while submitting them to the insurance companies.

Medical Necessity – This term refers to the services a patient requires for the treatment of a serious medical illness or condition and does not include cosmetic or investigative services.
Medical Record Number - This is a unique number given to a patient’s medical record so that it can be differentiated from other medical records.

Medicare - Medicare is a federal program that provides health coverage if you are 65 or older or have a severe disability, irrespective of your income. 

Medicaid - Medicaid is a state and federal program that provides health coverage if you have a very low income.

Modifier – These are CPT codes that are used additionally to explain any alterations or modifications to a treatment or service.

NPI – National Provider Identifier Number is a unique 10-digit number given to every healthcare provider in the USA.

Primary Care Physician – A physician who gives the basic healthcare services for a patient and recommends additional services if necessary for serious treatments.

PEC – Pre-existing condition is a medical condition of a patient that is in existence before receiving coverage from an insurance company.


For a bright prospective career in medical billing in Hyderabad, choose Avontix which is one of the top medical billing companies in Hyderabad.

Labels:

Comments

Post a Comment

Popular posts from this blog

Good Listening Skills Lead to Effective Communication - Avontix

Picture courtesy: toolshero.com T o engage in effective communication, one needs to listen properly and respond. We all know there’s a difference between hearing and listening. When a sound is sensed by the ears, hearing happens; this doesn’t require any special efforts. However, listening happens only when we consciously put efforts to understand the meaning of the words.This requires concentration on what others are saying. Listening by itself requires efforts, so one can understand that listening well requires much more efforts and concentration. To be able to mingle with others easily and actively participate in conversations, it is important that we listen well. Many people wrongly assume that if they are not talking much and letting others do the talking, they are good listeners. What happens in such cases is that they might be hearing to what others say rather than listening well. Listening is an art in itself that needs the practice to perfect. Here are some pointers...
Post a Comment
Read more

Common Medical Coding and Billing Myths -Avontix

Two functions of a healthcare organization that prove to be very vital for its operational and financial success are - medical coding and medical billing. Although professionals in medical coding jobs and medical billing jobs don’t serve the patients directly, they do interact with patients and handle a wide range of responsibilities in the healthcare facilities. A typical day of a medical coder or biller may include interacting with patients, physicians, nurses or health insurance providers. They ensure that they record all the patient information thoroughly and at the same time secrecy of the information is maintained. People, who wish to get into these jobs, have some wrong notions about medical coding and billing. Medical coding = medical billing : One myth about these jobs is that medical coding and billing are the same. No, both these professions are different and need different skills sets. It is true that both medical coding jobs and billing jobs require understan...
Post a Comment
Read more

Checking Claims Daily Proves Profitable for Facilities -Avontix

Picture courtesy: Google Images T here are many reasons for the failure of a healthcare facility and claims denial is a major concern for the facilities as it results in missing out on huge revenues that are due. Thus, it becomes vital for healthcare facilities to monitor the claims on a daily basis as a part of revenue cycle management. Usually, it is a practice to review the claims on a periodical basis such as weekly, monthly or quarterly which is very beneficial to analyze the effect of claims on the revenue cycle management and the financial prospects of the facility. But, reviewing the claims on a daily basis has its own plus points and helps in improving the revenues of the facility. By reviewing the claims as and when they are processed and examining all the claims submitted on a particular day at the end of the day ensures that the claims process is being followed appropriately and analyzed for a better revenue cycle management. Incorporating a daily review of t...
Post a Comment
Read more