Billers and coders work in medical facilities and hospitals, and are responsible for processing patient medical bills and insurance documents for health services rendered. In order to work in this field, it's important for prospective medical billers and coders to understand and recognize the common terms in the field to expedite their work.
Medical Claim
A medical claim is a payment request for medical services or benefits that a patient has received from a medical facility. Claims may be sent out to patients or health care providers, and are part of the billing cycle, which can take anywhere from a few weeks or months to complete. Unpaid medical claims may be sent collection agencies.
Reimbursement
Reimbursement in medical billing and coding refers to third-party billing in the health care industry. In order to work in medical coding and billing, individuals must have an understanding of reimbursement methodology and proper claim submission. Reimbursement may be conducted when patients pay out-of-pocket for medical services that should be covered by insurance companies.
Health Care Provider
A health care provider is an institution that provides preventative and rehabilitative medical services to patients. Patients or their employers pay premiums to health care providers who in turn cover the majority of medical expenses during a hospital visit. Medical billers and coders must be familiar with the various health care providers and understand their claims services.
Medicare/Medicaid
Medicare is the federal government's health insurance program for individuals who are 65 years and older. Younger individuals may also receive Medicare if they are living with disabilities or have received organ transplants. Medicaid serves low income families and provides vaccines for children, X-ray services, prenatal care and family planning services.
Medical Terminology
It's important for medical coders and billers to understand medical terms in order to bill accordingly. Terms may include systems in the body, tumor types, prefixes, suffixes, root words, diagnosis and medical conditions. Knowing and understanding medical terms can help in the billing process by saving time and money.
Tags: care providers, health care, health care providers, medical services, health care
