If you do not take the education first route for your medical billing or coding career, there are some basic sets of information you should know. Not only will this information help make your first days on the job easier, knowing some of these key industry words may help you land the job. Below are key acronyms, words and facts you should acquaint yourself with before starting your medical billing job.
Concepts Specific to Billing and Coding
HIPAA: Health Insurance Portability and Accountability Act. Passed in 1996, this act lays out guidelines for the collection and security of confidential health and medical record information. Things you should know about this act include the fact that it regulates the flow of information regarding patients. In order to bill most insurance companies or release medical records, you have to have a signed document on file from the patient.
HCFA-1500 and UB92: The two claim forms used in submitting charges to insurance companies for payment. HCFA-1500 forms are used in outpatient settings like doctor’s offices or medical equipment suppliers. UB92 forms are used for inpatient billing such as hospitals and rehab facilities. Each form has both a paper and an electronic version.
ANSI Codes: The American National Standards Institute has written documents to standardize the coding and electronic submission of claims and eligibility requests. ANSI formats exist for electronic claims (.837 files), electronic remittance advices (.835 files), eligibility requests to insurance companies (.270 files) and eligibility files returned from insurance companies (.271 files). There are also standardizations for claims remark and denial codes.
EOB/RA: The explanation of benefits or remittance advice is a paper or electronic file provided by the insurance company to the healthcare entity. The report details which line items or charges were paid for each patient. This is important when bulk payments are made, so providers know how to allocate funds to patient-specific accounts.
ICD-9 Code: The standardized diagnosis code for a given condition or disease.
HCPC: The Healthcare Common Procedure Coding System provides standardized codes for procedures, medications and equipment, allowing providers to bill insurance companies, work with fee schedules and code patient charts in a more efficient manner.
Medicare: Federal health insurance that covers seniors and certain disable persons. Medicare Part A covers inpatient stays and optional Part B coverage pays for physician’s visits and supplies.
Medicaid: State-level health coverage for indigent and disabled persons.
Managed Care: A type of insurance company that contracts with providers. Providers agree to a set fee schedule in order to be able to participate in the plan.
Common Abbreviations used in Medical Settings
AC: before eating
AOB: alcohol on breath, alternatively, assignment of benefits
ASAP: as soon as possible
bid: twice per day
BP: blood pressure
CC: chief complaint
CHF: Congestive heart failure
c/o: complaining of
DOB: Date of birth
DNR: do not resuscitate
ENT: ear, nose and throat
HEENT: head, ears, eyes, nose and throat
HS: at bedtime
ICU: Intensive care unit
LPN: licensed practical nurse
NKA: no known allergies
NPI: National provider identification number
NPO: nothing by mouth
OD: overdose, alternatively, right eye
OS: left eye
OU: both eyes
PC: after eating
PDR: physician’s desk reference
PO: by mouth
PR: by rectum
qd: every day
qh: every hour
qid: four times per day
R/O: rule out
SSN: Social security number
tid: three times per day
TO: telephone order
ud: as directed
UPIN: Unique provider identification number
WO: written order
YOB: year of birth
It addition to the above information, it is a good idea to read up on the specific provider type where you are interviewing or beginning work. Having a basic understanding of what services the company or physician provides prior to the interview will make you look more prepared and educated regarding the medical industry as a whole.