Health care professionals need to know and understand as part of their job responsibilities

 

 

 

 

As we have determined, there are many terms, abbreviations, and acronyms that health care professionals need to know and understand as part of their job responsibilities. It is important for you to familiarize yourself with the most common terms that a medical coder and billing specialist would be exposed to.

 

 

 

 


Using Medical Terms, Abbreviations and Acronyms on the Job

As we have determined, there are many terms, abbreviations, and acronyms that health care professionals need to know and understand as part of their job responsibilities. It is important for you to familiarize yourself with the most common terms that a medical coder and billing specialist would be exposed to.

Explore common medical abbreviations and acronyms used by coders and billers as they relate to insurance and reimbursement.

Include the following aspects in the assignment:
• Using Chapter 20 of 3-2-1 Code It, determine which application and layout will work best to create your resource. This may be a Word document using a chart or table, an Excel sheet, PowerPoint slide. or other application of your choice.  
• Select ten insurance and reimbursement abbreviations or acronyms that you feel you should be familiar with
• Define each of your selections in your own words
• Explain why you would need to know this information
• Discuss two strategies that you could use to help you increase your understanding and “library” of terms
• Locate and share an online site, resource, or personal template that can be used to save important healthcare/coding terms and abbreviations 
 

A system used by Medicare to classify hospital stays into groups for payment purposes.

Understanding DRGs is necessary for inpatient coding and billing, as it directly impacts the hospital's reimbursement for a patient's entire stay.

HMO

A type of managed care health insurance plan where you have to select a primary care physician within the network to coordinate all your care.

Knowing the rules of an HMO is essential for proper billing; otherwise, claims will be denied for out-of-network services or for not having a referral.

ICD-10

A code set used to classify diseases, signs, symptoms, injuries, and other health problems. It is used to justify the medical necessity of a service.

This is the foundation of medical coding. Without the correct ICD-10 code, a claim will be denied for a lack of medical necessity.

PPO

A type of health insurance plan that allows you to see any doctor or specialist, in or out of network, but you will pay less if you stay in the network.

Understanding PPO rules is important for patient education and for accurately calculating patient responsibility for out-of-network services.

RVU

A number that reflects the value of a service based on provider work, practice expenses, and malpractice insurance. It is used to calculate physician fees.

This is important for understanding how physician fees are determined and for helping providers understand their compensation and productivity.

Sample Answer

 

 

 

 

 

 

 

 

Common Insurance and Reimbursement Acronyms

Acronym/AbbreviationYour DefinitionWhy You Need to Know This
EOBA document from the insurance company that explains what services were paid, what was denied, and why. It's not a bill.It is crucial for understanding how a claim was processed, what the patient's financial responsibility is, and for identifying any errors that require an appeal.
HCPCSA two-part coding system for medical services and supplies, with the first level being CPT codes and the second level (Level II) covering non-physician services, drugs, and equipment.Knowing this helps you accurately bill for a wide range of services, supplies, and durable medical equipment, which is essential for proper reimbursement.
CMSThe federal agency that runs Medicare and works with states to administer Medicaid and other health programs.Understanding this is fundamental because CMS creates the rules and guidelines (like NCCI) that govern much of the U.S. healthcare system, including coding and billing.
A/RThe money that a healthcare provider is owed by patients or insurance companies for services rendered.You need to know this to track the financial health of the practice, follow up on unpaid claims, and ensure timely payment from all parties.
COBA system that determines which insurance plan pays first when a person has more than one plan.This knowledge is vital for preventing claim denials and ensuring that claims are submitted to the correct payer in the correct order.

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