Medical coding is necessary to process patient claims quickly so a doctor's practice can continue to run smoothly. You'll need to be fast on your feet in terms of understanding services, procedures, and complex insurance terms.
Coded information may come naturally to you, but even if it doesn't, it can be learned with practice and dedication. Here are several abbreviations you'll need to know. Study them as an informal way to determine how well you'd do in this profession.
Medical Acronyms You’ll Use
POS: A Point of Service is a type of insurance that refers to cheaper rates if the insured visits in-networks (INN) Health Maintenance Organization (HMO) providers. In an HMO practice, a large body of professionals all follow a set procedural plan. The patient will first see his or her PCP, or Primary Care Physician, and then if need be, the PCP will refer the patient to a specialist for further treatment.
CPT: The Current Procedural Terminology code is typically five digits and included on every bill.
AMA: When a patient leaves the doctor's care Against Medical Advice, this needs to be noted for insurance.
HIPAA: The Health Insurance Portability and Accountability Act works to protect patients’ personal information or medical conditions from falling into the wrong hands. There are strict rules about how those in healthcare can handle documents as well as patients’ rights to access their information.
EOB: An Explanation of Benefits lets the patient know which services were covered under his or her plan and the percentage paid.
PPO: A Preferred Provider Organization allows the insured more flexibility within his or her plan to see more doctors than in an HMO. It works for any doctor contracted within his or her insurance. It's as perfect for people who have been seeing the same doctor for years as it is for those who travel out of town often.
EDI: The Electronic Data Interchange is the computer system that distributes claims to the many insurance companies you work with so they can be routed to the right person.
In addition, you should know the code CMS, which is the Centers for Medicare (MCR) and Medicaid (MCD) Services. The growing number of older and financially disadvantaged patients means you'll likely have to learn these programs inside and out. Both of these services are run by the U.S. Department of Health and Human Services, so you'll also be working with federal government insurers as well as private companies.
Other common medical abbreviations will be for standard intake information like SSN (Social Security Number), DOB (Date of Birth), EDC (Effective Date of Coverage), DOS (Date of Service), BS (Blue Shield), BC (Blue Cross), and NP (New Patient).
You’ve Got What It Takes
As you go over the codes more, you'll find them easier to remember. You may forget the more obscure codes of services that aren't done very often, but you'll need to remember as much as possible for a smoother day and faster processing speed.
Training for your certification takes 1-2 years on average. Hear from a school near you about classes today!
