A medical billing and coding specialist needs to learn many things in a career college diploma program including medical insurance terminology. This terminology also comes in handy for medical assistants that are interested in becoming certified.

Medical Insurance Terminology

During the course of administrative tasks and insurance billing, medical insurance terminology is used to complete forms, analyze patient’s charts and process insurance claims. This terminology includes health plan terminology, employee benefit terminology, government medical terminology and medical coding terminology.

Health Plan Terminology

There are many health plans to choose from when a person pays for healthcare. Many health plans have the option of picking an HMO, PPO, or EPO. The HMO health plan may require the beneficiary to pick a primary care physician. Most employer health plans also allow an employee to use a health savings account to pay for medical expenses pre-tax.

HMO – Health Maintenance Organization; a health care financing and delivery system that provides health care services in a particular geographic area and requires the use of in-network plan providers.

PPO – Preferred Provider Organization; a health insurance plan that allows members to use in-network and out-of-network providers. The member will however receive a higher level of benefits from an in-network provider.

EPO – Exclusive Provider Organization; a managed care plan that covers services from doctors and hospitals in the plan’s network.

Primary Care Physician (PCP) – a physician that is the group member’s primary contact within the health plan. They provide basic medical services and authorize referrals to specialists and hospitals.

HSA – Health Savings Account; a personal savings account that allows participants to pay for medical expenses with pre-tax money.

Employee Benefit Terminology

Employees receive specific medical benefits as part of an employment benefits package. This can include short-term and long-term disability, workers’ compensation and COBRA.

Short-Term Disability – provides insurance that pays a portion of an employee’s income for a short period of time after they are out sick beyond their allotted sick leave.

Long-Term Disability – pays a portion of an employee’s income after both sick leave and short-term disability are exhausted.

Family Medical Leave Act (FMLA) – a federal law that guarantees up to 12 weeks of job protected leave for an employee that needs to take time off due to serious illness or disability, adoption of a child or to care for a family member.

Workers’ Compensation – an insurance plan that employers are required to have to cover employees who get sick or injured on the job.

COBRA – Consolidated Omnibus Budget Reconciliation Act; a federal law that allows individuals that have recently lost their job to temporarily keep health coverage.

Government Medical Terminology

Many federal and state government agencies offer healthcare assistance to the elderly and those with disabilities. Two of those plans are Medicare and Medicaid. The federal government also passed a law to make sure that everyone has access to medical benefits called the Affordable Care Act and that employers keep the workplace safe (OSHA).

Medicare – the federal health insurance program that provides health benefits to Americans age 65 and older. Medicare Part A covers hospital services and Medicare Part B covers doctor services.

Medicaid – a health insurance program, funded by federal and state governments, that provides health benefits to low-income individuals who cannot afford Medicare.

Affordable Care Act (ACA) – health care reform law that makes insurance affordable for more people and expands Medicaid programs to additional low-income Americans.

OSHA – Occupational Safety and Health Administration; requires employers to keep their work environment safe for workers.

Medical Coding Terminology

The healthcare industry has standard HIPPA-approved medical coding systems to bill insurance companies for procedures and services. The most common are ICD-10-CM, CPT and HCPCS.

ICD-10-CM –  The International Classification of Diseases, Clinical Modification is a system used by healthcare providers to classify and code all diagnoses, symptoms and procedures in conjunction with hospital care.

CPT – Current Procedural Terminology; a medical code set used to report medical, surgical and diagnostic procedures to physicians and health insurance companies.

HCPCS – Healthcare Common Procedure Coding System; coding for health care services such as ambulance, durable medical equipment, prosthetics, orthotics and other supplies used outside of a physician’s office.

Other Medical Terminology

Inpatient vs Outpatient – an inpatient is admitted to the hospital for medical or surgical services and provided meals, lodging, and overnight care. An outpatient receives healthcare services at a doctor’s office, urgent care center or other clinic where the patient is released within 24 hours of admission.

Does medical insurance terminology interest you? If you’re interested in numbers and organization, then a career in Medical Billing and Coding may be perfect for you! Medical Billing and Coding professionals are responsible for keeping the records, charts and bills in a medical office in order. With a career in Medical Billing and Coding, you can put your organizational and mathematical skills to the test to ensure healthcare facilities run smoothly. Contact us now to learn more about the Medical Billing and Coding program at Meridian College.