Millions of viewers love to watch “doctor shows” every week and thrill at the medical lingo, picking up bits and pieces of “doctor speak” and feeling knowledgeable and wise. This can be lots of fun as a viewer, but when knowing the ins and outs of not only medical terminology but also medical office terminology is your job it can be a challenge. There seems to be millions of important terms you need to know and it is important to know not only the etymology and roots of the medical words, plus the billing and coding lingo as well. Each is important and while you may not have to know the proper medical terms for each part of the skeletal system if you work for a Proctologist, it is important to have at least a cursory knowledge of all body systems. The billing and coding terms will be distinct as well, but will have overlapping nomenclature too.
Some medical office terminology is general. A “network” is the word for the interconnection between an insurer and the doctors, facilities, and providers that are contracted with that insurance company. An “out-of-network” provider is one that is not contracted with a specific insurer. It is vitally important to your patients that you know this difference as one will be paid at a higher rate than the other it they are paid at all. Some out of network providers are not payable at all except in some circumstances that are exceptions. An “exception” is a medical office term that means under certain conditions or contexts as dictated by the insurer a provider may be paid for services.
Every provider will also use the terms “allowable benefits”, “claim”, “co-payment” and “deductible”. These terms relate to what a payer will pay a provider, charges to the commercial payer, and payments made by the patient to the doctor, facility, or provider usually at the time of service but sometimes prior to the service or before the insurance company will pay. It is important to recognize that while these are common terms to all insurance companies and payers, the terms may not necessarily mean the same specific thing among each. Individual commercial payers have their own distinct language and while the norm is to keep terminology standard, it is important to take care that you learn the specifics for each commercial payer in order to ensure the patient and provider receive the most benefits.
Three very important terms specific to medical providers are HIPAA, ICD-9-CM, and Assignment and Authorization Forms. The Assignment and Authorization form is one of the first orders of business in a medical office as it gives the medical office the authority to bill the insurance company directly and receive payment for services rendered. This helps the patient by taking part of the responsibility off of them to file the insurance claim forms that can be confusing for those not skilled in medical billing techniques. Additionally, the commercial payer can pay the provider directly to avoid any delay in payment. HIPAA is the Health Insurance Portability and Accountability Act and is federally mandated. This Act specifies substantial penalties for noncompliance with the rules therein so knowledge of these are important. ICD-9-CM is the International Classification for Diseases, the 9th edition with Clinical Modifications. These are the standard codes for medical records and insurance claims. Created and monitored by the World Health Organization, the standardization of these alpha numeric codes helps patients by making it possible for physicians and medical providers anywhere to be able to understand what a doctor anywhere else in the world has diagnosed.
These are just a few of the thousands of medical office specific terms that a medical office professional needs to know. There are classes, schools, and certifications specific to medical office vocabulary. While each professional need not know every one of these terms, it is important that current resources are available if needed, and that medical office personnel have a working knowledge of most basic medical office terminology.