Billing Terminalogy....

Medical Billing Terminalogy

1.Participating Providers

2.Non – Participating Providers

3.Capitation

4.Fee For Service (FFS)

5.Referral

6.Referral Authorization Number (RAN)

7.Pre-Authorization or Pre-Certification

8.Pre-Determination

9.Waiver of Liability

10.ABN ( Advanced Beneficiary Notice)

11.PayBack or Refund

12.Offset

13. Pre-Existing Condition

14.Waiting Period

15.COB ( Coordination of Benefits)

16.Deductible

17.Copay

18.Co-Insurance

19.Out of Pocket Expenses

20.Stop Loss Clause

21.Contract Maximum

22.Providers Identification Number

 

Medical Billing Structures (What is Medical Billing?)

What is Medical Billing?

Medical Billing is an essential part of the  
healthcare industry. Medical billing involves on submitting claims and follow up on requests to insurance companies from 
healthcare providers to receive payments 
for services rendered to patients.

In short “Managing Financial Transactions 
of the Provider”      

Medical Billing Process in Back Office Work

Demo Entry

  Entering Patient Details, Guarantor Detail, Employer Detail and Insurance Information into the system. ROI and AOB obtained in front office from patient.

  Coding:

  Assigning predefined alpha numeric codes to procedure and diagnosis. The coding department take this work. They will also undertake hospital component other than professional component. 

  Charge

  Super bill / Encounter Forms are used to capture details like Date of Service, Referring Physician, Rendering Physician, Place of Service, Type of Service, CPT Codes, ICD Codes, Modifiers, Authorization or Referral Details and Copay Details.

  Claim Submission

  Claims can be submitted through Electronic or Paper format. Paper claims sent directly to the insurance. E-Claims initially sent to clearing house. Clearing house converts into insurance specific format and dispatch to the insurance.