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BILLING & COLLECTIONS

10 accurate acronyms ensure you get paid

Medical coding is primarily numbering, but acronyms are also important for accurate billing. Here are 10 of the most common. Keep this list handy for reference:

CMS (Centers for Medicare and Medicaid Services)Division of the United States Department of Health and Human Services that administers Medicare, Medicaid and the Children’s Health Insurance Program.

EDI (Electronic Data Interchange)Electronic systems that carry claims to a central clearinghouse for distribution to individual carriers.

EOB (Explanation of Benefits)Document, issued by the insurance company in response to a claim submission, that outlines what services are covered (or not) and at what level of reimbursement. Each payer has its own EOB form.

HIPAA (Health Insurance Portability and Accountability Act-Law)sometimes called the Privacy rule, outlines how certain entities like health plans or clearinghouses can use or disclose personal health information.

HMO (Health Maintenance Organization)Health management plan that requires the patient use a primary care physician who acts as a gatekeeper.

INN (in-network)A provider who has a contract with either the insurance company or the network with whom the payer participates.

OON (out-of-network)An out-of-network provider is one who does not have a contract with the patient’s insurance company.

POS (Point of Service-Health insurance plan) Offers the low cost of HMOs if the patient sees only network providers.

PPO (Preferred Provider Organization)Health management plan that allows patients to visit any providers contracted with their insurance companies. If the patient visits a non-contracted provider, the claim is considered out-of-network.

WC (Workers’ Compensation)U.S. Department of Labor program that insures employees who are injured at work.

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