Glossary of Medical Terms
This glossary highlights terminology not discussed more thoroughly on another page:
Arbitration - Arbitration is the process of dispute resolution where two opposing parties go before a judge to try to solve disputes. As it pertains to medical issues, compensation arbitration can be between the patient and either the insurance company or the employer who disputes the injury.
Billing - Also known as patient accounting or patient financial services, this is the department responsible for sending out and trying to collect on medical bills from insurance companies within hospitals or other healthcare facilities
Compliance - a term that came into vogue in 1997, as it applies to hospitals it's the process of setting up a way for hospitals and other medical facilities to monitor themselves to protect themselves against accusations of fraudulent or illegal activities
Durable Medical Equipment - more commonly known as DME, this is mainly considered as supplies that a patient can use at home as opposed to only being used within a medical facility. Many insurance companies will not cover this if given within a hospital setting, but some will cover a portion if a patient has to purchase them from a DME marketer
E&M Codes - this term stands for "evaluation and management", and is used to indicate what type of visit a patient is seeing a physician for, and for how long. It's also used in emergency room settings, as well as to indicate observation status. All medical practitioners use these codes.
FQHC - Federally Qualified Health Center. These are providers of medical services in urban and rural communities for those who may not have the means to receive health care in other ways. They offer a variety of medical services, sometimes including dental and psychiatric services.
Occurrence Codes - codes that help define a specific event that may affect how a medical claim is processed by an insurance company. They are broken down into accident codes, medical condition codes, insurance related codes and service related codes.
Pricing Transparency - This is a term used when talking about hospitals that are putting their charges online for the public to see. As of early 2008, 32 states have passed laws making this a mandatory requirement.
Referrals - also known as scripts, this is the signed piece of paper a patient takes to another provider of services such as lab, radiology, other physicians, or any other health care provider the primary physician wishes a patient to see.
Revenue Codes - Revenue codes are 3 digit codes that denote where and what types of services are being performed in a hospital setting. These codes will go on hospital bills, and are not used by physicians.
SNF - Skilled Nursing Facility, but also sometimes used as a description for a nursing home. Unlike a nursing home, it provides skilled rehabilitation services which may, over time, allow the patient to be able to go back home, and thus is a temporary arrangement. A person must have first been an inpatient for at least 3 days and then have a physician order the admission to have rehabilitation services at least 5 days a week.
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