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Tuesday, May 4, 2010

medical billing abbreviations and acronyms

ABN Advance Beneficiary Notice of Non-coverage
ADA American Dental Association; or American Diabetes Association
AIC MA Amount in Controversy (Medicare Appeals)
ALJ Administrative Law Judge
AMA American Medical Association
ANSI American National Standards Institute
ARA Associate Regional Administrator
ASA American Society of Anesthesiologists


ASC Ambulatory Surgical Center
AWP Average Wholesale Price
BBA Balanced Budget Act (of 1997)
BL Black Lung (Coal Miners)
BNA Bureau of National Affairs
CAC Carrier Advisory Committee
CAH Critical Access Hospital
CCI refer to NCCI
CCN Correspondence Control Number
CDC CERT Documentation Contractor
CDE Certified Diabetic Educators
CERT Comprehensive Error Rate Testing
CF Conversion Factor
CFR Code of Federal Regulations
CLIA Clinical Laboratory Improvement Amendments (If you perform clinical lab tests in your office, you need a CLIA number)
CMD Contractor Medical Director
CMHC Community Mental Health Center
CMN Certificate of Medical Necessity
CMP Civil Monetary Penalty
CMPL Civil Monetary Penalty Law
CMR Comprehensive Medical Review
CMS The Centers for Medicare & Medicaid Services
CNM Certified Nurse Midwife
CNMW Certified Nurse Midwife
CNS Certified Nurse Specialist
CO Central Office (CMS, in Baltimore, MD)
COB Coordination of Benefits
COBC Coordination of Benefits Contractor
CORF Comprehensive Outpatient Rehabilitation Facility
CP Clinical Psychologist
CPO Care Plan Oversight
CPT Current Procedural Terminology (5-digit codes, all numeric; Coding manual published yearly by the AMA)
CR Change Request
CRC CERT Review Contractor
CRD Chronic Renal Disease
CRNA Certified Registered Nurse Anesthetist
C-SNAP CMS Secure Net Access Portal
CSW Clinical Social Worker
CWAG Coalition of Wisconsin Aging Group
CWF Common Working File (Medicare Part A and Part B claims history and entitlement information database)
DC Doctor of Chiropractic
DDS Doctor of Dental Surgery
DEFRA Deficit Reduction Act of 1984
DG Documentation Guidelines
DHHS Department of Health & Human Services
DHSQ Division of Health Standards and Quality
DMD Doctor of Medical Dentistry
DME Durable Medical Equipment
DME MAC Durable Medical Equipment Medicare Administrative Contractor
DMEPOS Durable Medical Equipment, Prosthetics, Orthotics, and Supplies
DO Doctor of Osteopathy
DOB Date of Birth
DOL Department of Labor (Federal Agency)
DOS Date of Service
DP Doctor of Podiatry
DPM Doctor of Podiatric Medicine
DRG Diagnostic Related Grouping
DSC Doctor of Surgical Chiropody
DSP Doctor of Surgical Podiatry
DX Diagnosis/Diagnoses
ECF Extended Care Facility
EDI Electronic Data Interchange
EEG Electroencephalogram
EFT Electronic Funds Transfer
EGHP Employer Group Health Plan
EIN Employer Identification Number (Tax ID/SSN)
EKG Electrocardiogram
E/M Evaluation and Management (visit)
EMC Electronic Media Claims
EOB Explanation of Benefits
EPO Epoetin Alfa
ERA Electronic Remittance Advice
ESRD End Stage Renal Disease
F&A Fraud and Abuse
FCA Full Claim Adjustment; or False Claim Act
FCN Financial Control Number
FDA Food and Drug Administration
FI Fiscal Intermediary
FO Field Office
FOI Freedom of Information
FOIA Freedom of Information Act
FR Federal Register
FTE Full Time Equivalency; or Full Time Employee
FY Fiscal Year
GAO General Accounting Office; or Government Accountability Office
GPCI Geographic Practice Cost Index
GPRO Group Reporting Option
HBP Hospital Based Physician
HCPCS Health Care Procedure Coding System (5-digit, alpha-numeric procedure code)
HHA Home Health Agency
HHS Health & Human Services (CMS is a branch of)
HI Hospital Insurance
HIC Health Insurance Claim (Number)
HIPAA Health Insurance Portability and Accountability Act
HME Home Medical Equipment
HMO Health Maintenance Organization
HO Hearing Officer
HPSA Health Professional Shortage Area
HRSA Health Resources Services Administration
ICD-9-CM Internal Classification of Diseases-9th Edition-Coding Manual (three-, four-, or five-digit codes based on specificity)
ICN Internal Control Number
ICU Intensive Care Unit
IDTF Independent Diagnostic Testing Facility
IIC Inflation Index Charge-Customary
IIP Inflation Index Charge-Prevailing
IL Independent Laboratory
IOM Internet-Only Manual
IP Independent Psychologist
IPL Independent Psychological Laboratory
IRP Incentive Rewards Program
IVR Integrated Voice Response System
JAC Jurisdictional Advisory Committee
LCER Limiting Charge Exception Report
LFS Laboratory Fee Schedule
LLP Limited License Practitioner
LMRP Local Medical Review Policy
LVP Licensed Vocational Nurse
MAC Medicare Administrative Contractor
MCS Multi Carrier System (processing system for Medicare Part B)
MD Medical Doctor
MDM Medical Decision Making
MEI Medicare Economic Index
MEDPARD Medicare Participating Physician/Supplier Directory
MIM Medicare Intermediary Manual (Part A)
MIP Medicare Integrity Program
MMA Medicare Modernization Act
MPFSDB Medicare Physician Fee Schedule Database
MR Medical Review
MR/UR Medical Review/Utilization Review
MSN Medicare Summary Notice
MSP Medicare Secondary Payer
MSO Management Service Organization
NA Non-assigned (claim)
NCCI National Correct Coding Initiative
NCD National Coverage Decision
NDAB National Diabetes Advisory Board
NDC National Drug Code
NETT National Emphysema Treatment Trials
NH Nursing Home
NMW Nurse Midwife
NOC Not Otherwise Classified Code (Anytime you use an NOC code on your Medicare claim, you must provide a detailed description of the service provided)
NON-PAR Non-Participating Provider
NOS Number of Service(s)
NP Nurse Practitioner
NPI National Provider Identifier
NPP Non-Physician Practitioner
NPRM Notices of Proposed Rule Making
NSC National Supplier Clearinghouse
NSF National Standard Format
OAS Office of Audit Services
OCFAA Office of Civil Fraud and Administration Adjudication
OCR Optical Claim Recognition
OD Doctor of Optometry
OI Office of Investigations
OIFO Office of Investigations Field Office
OIG Office of Inspector General
OMB Office of Management & Budget
O/P Overpayment
OPPS Outpatient Prospective Payment System
ORF Outpatient Rehabilitation Facilities
OSCAR Online Survey, Certification and Reporting (OSCAR System)
OT Occupational Therapist
OV Office Visit
PA Physician Assistant
PAR Participating (physician)
PAYER-ID Payer Identification (Number)
PC Professional Component
PCA Progressive Corrective Action
PDT Purchased Diagnostic Test
PECOS Provider Enrollment Chain and Ownership System
PHC Public Health Clinic
PHSA Public Health Service Act
PI Program Integrity
PIM Program Integrity Manual
PIMR Program Integrity Management Reporting System
PM Program Memorandum
POE AG Provider Outreach and Education Advisory Group
POS Place of Service or Point of Service Option (for an HMO)
PPO Preferred Provider Organization
PPR Physician Payment Reform
PPS Prospective Payment System
PPV Pneumococcal Pneumonia Vaccine
PQRI Physician Quality Reporting Initiative
PRN Provider Remittance Notice
PSC Program Safeguard Contractor
PT Physical Therapy; Physical Therapist; or Patient
PTAN Provider Transaction Access Number
QA Quality Assurance
QDC Quality Data Codes
QIO Quality Improvement Organization
RA Remittance Advice
RAC Recovery Audit Contractor
RBRVU Resource Based Relative Value Unit
RC Reasonable Charge
REP PAYEE Representative Payee
RHC Rural Health Clinic
RHHI Regional Home Health Intermediary
RN Registered Nurse
RO Regional Office (CMS)
ROS Review of Systems
RPT Registered Physical Therapist
RRB Railroad Retirement Board
RVU Relative Value Unit
RX Prescription
SDP Single Drug Pricer
SHIP Senior Health Insurance Program; or State Health Insurance Assistance Program
SMI Supplemental Medical Insurance
SNF Skilled Nursing Facility
SOS Site of Service
SP Specialty
SPR Standard Paper Remittance
SSA Social Security Administration
SSI Supplemental Security Income
SSN Social Security Number
TAN Treatment Authorization Number
TC Technical Component
TIN Taxpayer Identification Number
TMJ Temporomandibular Joint Dysfunction
TOS Type of Service
UR Utilization Review
USC United States Code
VA Veterans Administration
WC Worker's Compensation
WPS Wisconsin Physicians Service
YTD Year-to-Date
ZPIC Zone Program Integrity Contractor
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Medical Billing

What is the overall Billing process?

The physician doesn’t get paid for his services immediately after they are rendered. Majority of the patients have insurance coverage and details of such coverage are provided to the physician before treatment. It is the responsibility of the physician to submit claims to the insurance company and get paid for his services. Submitting Claims and getting paid is a lengthy process and involves a lot of rules and regulatory systems and is very complicated. The physician needs to adhere to all these rules before submitting claims. This is the concept of Medical Billing. Sometimes the physician cannot provide his entire attention to this activity. He entrusts this activity to Billing Companies. This is a process of the physician providing rights to Billing Companies to bill Medical Insurance claims in order to save his time energy, and money.

After the provider renders services to the patient, the billing company will submit bills to the insurance company/ payer, using the insurance information that was last provided, as well as information about the reason for the examination, and the exact type of procedure performed.

Medical coding is the process of converting Medical terms to numeric code and it required Medical knowledge skills.

Medical billing is the process of submitting the claims and get paid behalf of provider.

I have listed the important process in Medical Billing. Each process is very important.


1. Insurance verification.

2. Demo and Charge entry process.

3. Claim submission.

4. Payment posting.

5. Action on denials or Denial management or Account receivables.


Insurance verification

Process started from here and usually front desk people are doing this process. Its a process of verifying the patients insurance details by calling insurance or through online verification. If this department works well, we could resolve more problem. We have to do this even before patient appointment.

Demo and Charge entry process

Demographic entry is nothing but capturing all the information of patients. It should be error free.

Charge-entry is one of the key departments in Medical Billing. Key department?? Yes, that's true. It is the keying-in department in Medical Billing. After receiving the super bills from the Doctor's office, it gets passed through the coding department, and then comes to the charge-entry department.


A Charge-entry person also has one other vital role to perform. That is, to look-up the codes entered in the claim, and to assign the relevant charges for those codes.

Claim submission Process

The next step after demographics and charge entry is claim generation. Claims may be paper claims or electronic claims. There are various types of forms for paper claims. The most widely used form is Health Care Finance Admin-1500 designed by the Health Care Financing Administration.

Electronic transmission of claims is the modern way of sending claims with less paper work. The most common means of transmission are through internet . The claim information is directly loaded into the insurance company's computer system or to the clearing house.


Payment Posting Process

Once the claims reach the carriers and they complete processing, they issue a check and prepare an Explanation of Benefits . The checks and the Explanation of Benefits would be sent to the pay-to address with the carrier or in the Health Care Finance Administrators.


In this processing we have accounted the money into the account as per the Explanation of Benefits. Now a days we are using Electronic payment posting also.

Action on denials or Denial management or Account Receivables

This is a most important function in the process flow of data. Unless this is taken care of, insurance balance will only be on an upward trend.

Problem in Medical Billing

•Inaccurate or lack of coding

• Incomplete claims

• Lack of supporting documentation

• Poor communication with the payer

• Not billing for services rendered

* Not being follow up AR balance claims


The person who is doing this process will be called Medical billing specialist.

Who is Medical Billing Specialist.

Medical billing Specialist is the one who is handling the below process and having well knowledge in each and every process.

* Insurance verification process

* Patient demographic and charge entry process.

* Submitting the claims by electronic as well as paper method. Tracking various claim submission report.

* Payments posting process for insurance as well as patient.

* Denial management.

* Insurance followup management.

* Insurance appeal process.

* Handling patient billing inquiries.

* Patient statement process.

* Preparing monthly reports such as revenue report and account receivable report and as per the provider requirement.

Medical Billing Specialists are in charge of reviewing patient charts and documents. They prepare and review all medical insurance claims based on the rules and regulations of insurance companies. Medical Billing Specialists also review insurance communications, payment and rejection notices to properly track all claims and payments.


Medical Billing specialist Professional

If a person is computer literate he is a fit enough candidate to take up the profession of medical billing and medical coding. However he will need to be trained and be aware of a lot of new information before he can start working effectively. He has to learn about the medical billing software and must be familiar with and master the various commands used while working with it.


Who are medical coders and how is it related to medical billing? Medical billing is a sub specialty of medical coding. Medical coding is the first step in the billing process. All patient records are maintained using the ICD-9 index system so that it is compliant with the federal rules.

A medical Biller’s most important skill includes filling up of the various medical forms correctly without any mistakes what so ever. All information required should be complete without any mistake at all. And the work will be include the following

Patient demographic entry

Insurance enrollment

Charge entry

Insurance verification

Billing and reconciling of accounts

Payment posting

Insurance authorization

Medical coding

Scheduling and rescheduling

Account receivable follow-ups and collections

Is it worth taking a medical billing program?

Usually don't spend too much cost on Medical billing program because the program will not do anything with real experience. What you learn from these kind of program will not be going to match with when you are working in the real environment. Hence just use as the start kind of program and get the real time experience even in small salary and later you can come up with more demanding one.


Problem of In House Processing of Medical Claims

Medical claims are generally very complex and have long extended details. While processing medical claims, one has to be highly critical and do efficient follow-up in order to get results. The process requires a lot of time and effort. And even after all this, there can be cases where files get lost or a small error can ruin the entire lot and everything has to be re-submitted again. Usually practice staff can be held up with lot of current work rather than submitting the claim and resubmitting the corrected claim hence it will lead to time delay on payment flow and it will affect all the relationship with in the practice. Even cost wise is also not effective when compare to outsourcing.

Advantage of Medical Billing Outsource

Medical Billing Company helps you in managing all your billing requirements proficiently. By choosing right medical billing company, you can get benefit such as improved financial strength.

Medical Billing task is very tedious and time consuming. However, billing must require more accuracy and special attention to strengthen the financial condition of clinical or hospital. You can do this task at own or assign to clinical staff but you have to be pleased with low patients satisfaction. Medical billing company can help you in supportive task. By efficient medical service, you will get highly satisfied patients.

A Medical Billing service can improve the efficiency of your billing system, reduce denials, cut down operating costs, boost reimbursements and save valuable time that can be devoted to patient care. These services are better equipped to adapt to continuously changing billing codes and industry requirements.


* Prince is low compare to doing it in house

* Dedicated Highly Skilled Professionals

* No need to maintain the hardware . Ability to perform Medical Billing remotely, using the software of your choice

* Usually Maximum reimbursements and fewer denials

* Accuracy is high when compare

* Faster transaction


Question need to ask when Medical Billing Outsourcing

1. Check with their referral and how long they are doing this business.

2. Are they HIPAA compliance

3. Where they are doing their work. If possible just visit there.

4. Data security.

5. Compare the price with others.

6. what are the reports they will provide

7. Your specialty wise question

8. Their software skills.


Services and process involved in Medical Billing

* Coding ( CPT, ICD-9, and HCPCS)

* Patient Demographics Entry

* Charge Entry – All specialties

* Payment Posting (Manual and Electronic)

* Payment Reconciliation

* Denials/rejections analysis, re-billing

* Accounts Receivable Follow-up

* Systemic A/R projects, re-billing

* Collection Agency Reporting

* Refunds


Medical Billing Salary Range

Depending on the education qualification, the hourly rate varies from $12-$15. Another most important factor that affects billing pay is how long someone has worked in the field. Medical specialist with experience of 1 year earns around $12 per hour. Those who have more experience in billing earn up to $16 per hour. However, the geographic location also plays a role in pay scale. For instance, areas where cost of living is high, the pay will be more. Billers who work in New York City, Houston, Chicago and California are able to pull a good amount of salary. Work locations such as hospital, billing company or private practice will also affect the salary. Since there are lots of factors which affect the salary of billing, it is really not easy to predict the pay scale. Studies have shown that 50% of people earned around $35,000-$45,000 annually.


Most of the medical Billers are paid hourly, rather than annually. While Biller who is experienced can earn around $40,000 a year as an independent contractor working from home, a billing and coding specialist who runs his own firm can earn $100,000 a year. However, people who are searching for home based job should be very careful. There is lots of fraud going on in this field. These spammers charge hundred to thousand dollars and in exchange they claim they will help to get a placement in billing. They also promise that medical billing job can earn a substantial amount of money and no experience required. But in reality, those who paid to get a job end up with no job, no money. Billing is a very competitive field, so without experience or training in medical billing field, it is almost impossible to get a job.

Selecting Medical Billing Software - 10 things to consider

1. The first step is to evaluate your needs. And when evaluating different systems look for a package that goes one step ahead of billing. Choose a medical practice management system MPP. This will handle considerably more that just medical billing.

2. Determine whether the system handles electronic transmission of claims, direct billing for patients, co-pays, co-insurance, and expenses not covered by insurance.

3. Weigh the pros and cons of different medical billing systems and ask to see a system in operations. Always check out the references yourself.

4. Look for a medical billing management system that is user friendly. When a vendor demonstrates get your office staff to be present. This way you will be able to check how the software functions. Any software must be easy to use to be productive. The system should be fool proof.

5. Ask whether the medical billing software is a traditional system, one that will work on your office computers or an application service provider system (ASP), one that will process data at the software company’s data center.

6. Always get quotes from at least three medical billing software providers.

7. Ask whether they are offering an evaluation period or trial. This will enable you to know in actuality whether the system works or not.

8. Find out about training your office people, up-gradation of system, and whether the software is compatible with your office computer systems

.9. Find out whether the system will handle appointment scheduling, maintenance of records and so on apart from electronic medical records, SOAP notes, and billing. Choose a system that is comprehensive.

10. An ideal Medical Billing software system must include aspects like payment posting, reconciliation; follow up, secondary submission, and patient billing.Choose a transparent billing system that enhances your office efficiency. Install a system that you can use not one that will lead to frustration and problems.Medical billing systems must free your time and that of your office staff not make you run in circles. Choose a system with care.

Disclaimer

All the contents and articles are based on our experience and our knowledge in Medical billing. All the information are educational purpose and we are not guarantee of accuracy of information. Before implement anything do your own research. All our contents are protected by copyright laws and guidelines.
If you feel some of our contents are misused please mail me at medicalbilling4u@gmail.com. We will response ASAP.